LTR Reservation Ottawa - Hull - Halifax Please note that all fields followed by an asterisk must be filled in. First Name*
Last Name*
E-Mail Address*
City
Zip/Postal Code*
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1. Cell Phone# on the day of the training?
2. Student(s) Full Name** 3. Student(s) Gender, Age*
4. Student(s) Height (inches"), *
5. Student(s) Weight (lbs)*
6. Student(s) Inseam **CRITICAL** (foot to highest point between legs) Inches" TO ENSURE TOP TUBE CLEARANCE ON TRAINING BICYCLE
7. Type of Training*
---Select--- Private L-Ride Pkg 1st Time: 2hr 1st time + 1-1/2hr session
Priv. Tri-Trn'g pkg: 2 hr 1st time+ two 1-1/2hr sessions
Priv.Dual Tri-Trn'g pkg: two 2 hr 1st time+four 1-1/2hr sessions
Private 2 hour available after 1st trng pkg completed
Youth 2 Children 13yrs or less L-Ride Pkg: 3 hr session
Youth 2 Children 13 yrs or less L-Ride Pkg: 3hours + 1-1/2hr session
Youth Tri-Trn'g Pkg 2 kids 13yrs or less, three - 3hour sessions
YOUTH 2 TEENS 14-18yrs L-Ride Pkg 3 hr session
YOUTH 2 Teens 13-18 yrs L-Ride Pkg: 3hours + 1-1/2hr session
YOUTH Tri-Trn'g Pkg 2 TEENS Age 14-18yrs, three - 3 hour session
YOUTH with one Adult 19yrs+ L-Ride Pkg: 1-1/2 hr session
8. Other training 9. Preferred dates 10. Dates, Special Requests 11. Day(s) of week preferred 12. Preferred Time(s) of Training (give 2) 13. Location of trainig
---Select--- Ottawa - Nepean
Halifax Nova Scotia
Dartmouth Nova Scotia
14. BICYCLE options 15. Helmet options 16. STUDENT Helmet size (Teens - Adult) 17.student #2 Helmet size 18. Why do you feel, you need training? 19. What motivates you (student) to learn to ride a bicycle? 20. I wish to experience 21. I wish to CYCLE 22. What motivates you to learn to ride a bicycle? 23. Choose what best describe Your scenario 23a. Other 24. I want to be able to cycle? 25. What type of cycling do you want to experience? 25a. Other 26. Rank your Pain Factor
---Select--- I am constantly taking pain killers
I fall apart at the first onset of any discomfort or pain
If I'm not comfortable, I feel, I can't do it
If I get a scratch, I feel I need immediate attention
I don't see the benefit of discomfort or pain
I can withstand a scratch, bruise or fall here or there
Anything worthwhile involves experiencing some form of discomfort or pain
Discomfort or pain doesn't bother me
No Pain, No Gain
I am athletic, and work out on a regular basis. PAIN = GAIN
Life's full of risks, and I'm willing to take it all on!
26a. Other
27. Does the student have a learning disability, mental or physical chalenges?* 28. Does the Student(s) have any health issues, if yes, you may be required to complete an assessment.* 29. If "Yes" please specifiy , also, add a website link for more information on this topic. 30. I agree to the following* 31. I acknowledge 32. I agree to the following* 33. I agree to the following*
I realize when raised in certain environments, a persons mindset may have limited flexibility and/or adaptability to change and can result in increased number of training sessions and/or emotional onsets, that are not tolerated by our trainers. To successfully move forward, Your trainer, will expect performance and consistent improvements and adaptability, or he will have no choice but to increase the sessions to suit the students learning curve, yielding results. Our trainers are very patient, encouraging perseverance and at times will also encourage and nurture successful achievements. I realize, A person will take longer to learn new skills, If they lack Life skills, Life skills are developed by been exposed to multiple sports, athletic experiences, and hands on activities that increase coordination and confidence.
34. I accept* Additional comments