Registration Ottawa-Gatineau-Montreal-Halifax
Please note that all fields followed by an asterisk must be filled in.
I have Chosen
Training Location*
---Select--- OTTAWA - Downtown
OTTAWA - Ontario
KANATA- Ontario
GLOUCESTER- Ottawa
NEPEAN - Ontario - 15 km South of Ottawa
NEPEAN - Ontario 15 km South of Ottawa, if there no availability here, I will come to Gatineau Quebec, 15 km North of Ottawa
GATINEAU - Quebec 15 km North of Ottawa
GATINEAU - Quebec 15 km North of Ottawa, if there no availability here , I will come to Nepean Ontario, 15 km South of Ottawa
KIRKLAND - Quebec
SENNEVILLE - Kirkland
SAINTE-ANNE-DE-BELLEVUE
MONTREAL QC - Downtown
DORION / Vaudreuil - Quebec
CORNWALLL - Ontario
Other Location, with this option I will provide a location that meets Born To Ride Bicycle's REQUIREMENTS
SAINT JOHN - New Brunswick
HALIFAX - Nova Scotia
DARTMOUTH - Nova Scotia
7. Type of Training*
ADDITIONAL CITIES (Subject to approval)
---Select--- PICKERING - STUDENT PROVIDES LOCATION
AJAX - STUDENT PROVIDES LOCATION
WHITBY - STUDENT PROVIDES LOCATION
OSHAWA - STUDENT PROVIDES LOCATION
BOWMANVILLE - STUDENT PROVIDES LOCATION
NEWVCASTLE - STUDENT PROVIDES LOCATION
BELLVILLE - STUDENT PROVIDES LOCATION
NAPANEE - STUDENT PROVIDES LOCATION
KINGSTON - STUDENT PROVIDES LOCATION
GANANOQUE - STUDENT PROVIDES LOCATION
DARLINGSIDE - STUDENT PROVIDES LOCATION
BROCKVILLE - STUDENT PROVIDES LOCATION
IROQUOIS - STUDENT PROVIDES LOCATION
EASTERN PROVINCES, SPECIFY ADDRESS OR CITY OF CHOICE, INCLUDE POSTAL CODES
CUSTOMER, First and Last Name*
Last Name*
Cell Phone 1-*
Alternative Phone 1-
E-Mail Address*
Street Address
C I T Y and Postal / Zip Code*
Best days & hours to Call*
1. Cell Phone# on the day of the training
I agree to provide *
STUDENT........... 2. Student(s) Full Name**
Students Gender*
OTHER
3. Student(s) Age*
4. Student(s) Height (inches")*
5. Student(s) Weight (lbs)*
6. Student(s) **CRITICAL** (measure floor to highest point between legs) Inches" TO ENSURE TOP TUBE CLEARANCE ON TRAINING BICYCLE INSEAM (INCHES")
I*
Additional students
8. Other training
I WISH TO START MY TRAINING IN THE MONTH(S) OF
11. Preferred Day(s)*
12. Preferred Time(s) two 2*
10. ENTER PREFERRED DATES, Special Requests
14. I will need
15. I accept*
16. Helmet options*
17. STUDENT Helmet size (Teens - Adult)
Additional Students information
19. Why do you feel, you need training?
20. What motivates you (student) to learn to ride a bicycle?
23. Choose what best describe Your scenario*
21. I wish to experience
25. What type of cycling do you want to experience
23a. 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 challenges*
28. Does the Student(s) have any health issues, if yes, you may be required to complete an assessment.**
29. If "Yes" please specify , 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 realize*
34. I accept that*
35. I acknowledge:*
36. I accept that*
In preparation for my training session(s), I will complete the following activities sports and/or exercises *
Other Cardio/intensity
How often will you complete the above sports/exercises prior to your session*
Other
When I finally meet*
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