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Assessment Reservations

Please note that all fields followed by an asterisk must be filled in.

First Name*

Last Name*

E-Mail Address*

City*

Cellular/Mobile Phone*

Student's Full Name*

Select which program/option best describes you

	Assessment for CycleSafe
	Assessment for Learn To Ride
	Learn To Ride - 30 minute session(s)
	Assessment for Becoming a Road cyclist
	Assessment for Cycling competition
	Assessment/Preparation for a Cycling Tour

Helmet Options*

Student 2. Helmet Options

Do you need our bicycle

	YES
	NO

Student 2. Do you need our bicycle?

	YES
	NO

Gender, Age, Height, Weight*

Student 2. Gender, Age, Height, Weight

**Critical**INSEAM measure from floor to highest point between legs.

Student 2.*INSEAM measure from floor to highest point betwen legs.

Cycling Skill level*

Student 2. Cycling Skill level

Comments:

Do you have any form of Disabilities or Health issues

	Yes
	No

Please explain your Disability(s), health issue, or special needs or requirements

Choose a Location for your Assessment *

Weekdays prefered times

Weekends preferred times

Why do you feel you need an assessment or wish to enroll in one of our training programs?

I Acknowledge the following*

You have either asked for an assessment, or we require you to have an assessment; to bring clarity to your abilities, and ensure your success or to determine eligibility. in either case, Your trainer will provide tips and advice, and introduce you to what's to come in your 1st time, 2 hour training session. An assessment is a great way to start you off. you will get your questioned answered within your 30 minute assessment.

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Assessment Reservations

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