LTR Reservation Ottawa-Gatineau-Halifax

Learn to Ride in Ottawa ON, Gatineau Quebec, Halifax Nova Scotia this summer on select days only. Fill out the reservation form to select your date preference, time and type of training......

This Form cannot be submitted until the missing fields (labelled below in red) have been filled in
Registration Ottawa-Gatineau-Montreal-Halifax
Please note that all fields followed by an asterisk must be filled in.
DISCLAIMER/REQUIREMENTS, All *
Information contained within this Registration, Is private and confidential, and is treated as such, and is NOT sold or used by any third party organization for any financial benefit. The main purpose of the form is to provide accurate information to help our trainers, bicycle mechanics and staff to improve experience and increase results to the student and/or supporting parents directly involved. Les informations contenues dans cet enregistrement, sont privées et confidentielles, et sont traitées comme telles, et ne sont PAS vendues ou utilisées par une organisation tierce pour tout avantage financier. L’objectif principal du formulaire est de fournir des informations précises pour aider nos entraîneurs, nos mécaniciens de vélo et notre personnel à améliorer l’expérience et à augmenter les résultats pour l’élève et / ou à soutenir les parents directement impliqués.
I have Chosen
TO GET STARTED NOW! ON LEARNING TO RIDE, Want to schedule a date/POUR COMMENCER MAINTENANT! SUR APPRENDRE À ROULER, Vous voulez planifier une date IMPROVE MY CYCLING SKILLS/AMÉLIORER MES COMPÉTENCES EN CYCLISME The EQUAL PAYMENT PLAN OTTAWA/GATINEAU / LE PLAN DE PAIEMENTS ÉGAUX OTTAWA/GATINEAU CONTINUATION OF MY TRAINING/POURSUITE DE MA FORMATION OTHER/AUTRES
Other/AUTRES
Date & length of last session / Date et durée de la dernière session
COMMENTS/COMMENTAIRES
Training Location / Lieu de formation*
---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
ADDITIONAL CITIES (Subject to approval) VILLES SUPPLÉMENTAIRES (Sous réserve d’approbation)
---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
OTHER ADDRESS / LOCATION PREFERRED
7. Type of Training*
Cycle Safety Training Techniques, Control, Interpretation, Communication Techniques de formation à la sécurité du cycle, contrôle, interprétation, communication Tri-Trn'g pkg: 2 hr 1st time+ two 1-1/2hr sessions Tri-Trn’g pkg: 2 h 1ère fois + deux sessions de 1-1 / 2 heures PENTATRACK-TRAIN’G PKG 1-30 MINUTYE PREP/EXERCISE + FIVE 1-1/2 HR PENTATRACK-TRAIN’G PKG 1-30 MINUTYE PREP/EXERCICE + CINQ 1-1/2 HR MOMENTUM PKG 1-30 MIN+1-2HR 1ST TIME+FOUR 1-1/4 HOUR S'SSN MOMENTUM PKG 1-30 MIN+1-2HR 1ÈRE FOIS +QUATRE 1-1/4 HEURE SSN CHILDREN PKG 1-2 HR + FIVE 1-1/4HOUR S'SSNS CHILDREN PKG 1-2 HR + FIVE 1-1/4HOUR S'SSNS CHALLENGING CHILDRENS PKG 1-30MIN+1 1-1/2HOUR+6 1-1/4 HOUR S'SSN DÉFIER LES ENFANTS PKG 1-30MIN +1 1-1/2HOUR+6 1-1/4 HEURE SSN ONE 3 HOUR TWO STUDENT PKG UNE 3 HEURES DEUX ÉTUDIANTS PKG TWO 3 HOUR TWO STUDENT PKG DEUX 3 HEURES DEUX ÉTUDIANTS PKG THREE 3 HOUR TWO STUDENT PKG TROIS 3 HEURES DEUX ÉTUDIANTS PKG ASSESSMENT 45 MINUTES limited available dates/times ÉVALUATION 45 MINUTES dates/heures limitées disponibles 2 hour Learn To Ride Session, Available after 1st Training Package is completed, Subject to approval Session d’apprentissage de 2 heures, disponible après la 1ère trousse de formation, sous réserve d’approbation 1-1/2 hour Learn To Ride Session, Available after any 2 hour session, Subject to approval 1-1/2 heure Apprendre à rouler Session, Disponible après toute session de 2 heures, Sous réserve d’approbation L-Ride Pkg two - 3 hrs + 1-1/2hr session L-Ride Pkg deux - 3 heures + 1-1 / 2 heures de session YOUTH with one Adult 19yrs+ L-Ride Pkg: 1-1/2 hr session JEUNESSE avec un adulte 19 ans + L-Ride Pkg: 1-1 / 2 session d’heure OTHER / AUTRES
I realize both / Je me rends compte des deux*
2 hour and 1-1/2 hr training sessions are available after, I have completed a training package, and cannot be taken without prior approval, Call: 1-855-795-4482 / Des séances de formation de 2 heures et de 1-1/2 heures sont disponibles après, j’ai suivi une trousse de formation et je ne peux pas être suivi sans approbation préalable, Appelez : 1-855-795-4482
PLEASE*
Help us understand you the CUSTOMER and/or the STUDENT, The CUSTOMER: The person Registering/Paying for the session(s). The STUDENT: Person been trained. NOTE: "customer" should be the same person attending the session with the student, for best results, we need to understand BOTH you and the "student" and the relationship between the two, Thank You for your cooperation./ Aidez-nous à vous comprendre le CLIENT et /ou l’ÉTUDIANT, Le CLIENT: La personne qui s’inscrit / paie pour la (les) session (s). L’ÉTUDIANT : La personne a été formée. REMARQUE: « client » devrait être la même personne assistant à la session avec l’étudiant, pour de meilleurs résultats, nous devons comprendre à la fois vous et l'«étudiant » et la relation entre les deux, Merci pour votre coopération.
CUSTOMER IS THE / LE CLIENT EST LE*
---Select---STUDENT SPOUSE PARENT GUARDIAN GRANDPARENT AUNT UNCLE NEPHEW NIECE FREIND SPONSOR DISTANCE RELATIVE OTHER: DETAILS BELOW
OTHER
CUSTOMER, Rank your Pain Factor (Do Not complete if you are the STUDENT) CLIENT, Classez votre facteur de douleur (Ne pas compléter si vous êtes l’ÉTUDIANT)
---Select---1. I am constantly taking pain killers 2. I fall apart at the first onset of any discomfort or pain 3. If I'm not comfortable, I feel, I can't do it 4. If I get a scratch, I feel I need immediate attention 5. I don't see the benefit of discomfort or pain 6. I can withstand a scratch, bruise or fall here or there 7. Anything worthwhile involves experiencing some form of discomfort or pain 8. Discomfort or pain doesn't bother me 9. No Pain, No Gain 10. I am athletic, and work out on a regular basis. PAIN = GAIN 11. Life's full of risks, and I'm willing to take it all on!
CUSTOMER / CLIENT*
YES, I KNOW HOW TO RIDE A BICYCLE / OUI, JE SAIS FAIRE DU VÉLO NO, I DO NOT KNOW HOW TO RIDE A BICYCLE / NON, JE NE SAIS PAS COMMENT FAIRE DU VÉLO
CUSTOMER, IF YOU DO, HOW DID YOU LEARN TO RIDE ? / CLIENT, SI VOUS LE FAITES, COMMENT AVEZ-VOUS APPRIS À ROULER ?
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 / Meilleurs jours et heures d’appel*
1. Cell Phone# on the day of the training / 1. Numéro de téléphone cellulaire le jour de la formation
I agree to provide / J’accepte de fournir *
For standardization of proper fit I WILL USE THE Imperial system, TO PROVIDE ALL MEASUREMENTS ON THIS FORM IN : Feet - inches and LBS / Pour la normalisation de l’ajustement approprié, je vais utiliser le système impérial, POUR FOURNIR TOUTES LES MESURES SUR CE FORMULAIRE DANS: Pieds - pouces et LBS
Provide STUDENT a)___F U L L_____N A M E (S) / Fournir à STUDENT a)___F U L L_____N A M E (S)*
Student a) Rank your Pain Factor Étudiant a) Classez votre facteur de douleur*
---Select---1. I am constantly taking pain killers 2. I fall apart at the first onset of any discomfort or pain 3. If I'm not comfortable, I feel, I can't do it 4. If I get a scratch, I feel I need immediate attention 5. I don't see the benefit of discomfort or pain 6. I can withstand a scratch, bruise or fall here or there 7. Anything worthwhile involves experiencing some form of discomfort or pain 8. Discomfort or pain doesn't bother me 9. No Pain, No Gain 10. I am athletic, and work out on a regular basis. PAIN = GAIN 11. Life's full of risks, and I'm willing to take it all on!
Provide STUDENT b) ___F U L L_____N A M E (S) / Fournir STUDENT b) ___F U L L_____N A M E (S)
Student b) Rank your Pain Factor / Étudiant b) Classez votre facteur de douleur
---Select---1. I am constantly taking pain killers 2. I fall apart at the first onset of any discomfort or pain 3. If I'm not comfortable, I feel, I can't do it 4. If I get a scratch, I feel I need immediate attention 5. I don't see the benefit of discomfort or pain 6. I can withstand a scratch, bruise or fall here or there 7. Anything worthwhile involves experiencing some form of discomfort or pain 8. Discomfort or pain doesn't bother me 9. No Pain, No Gain 10. I am athletic, and work out on a regular basis. PAIN = GAIN 11. Life's full of risks, and I'm willing to take it all on!
Student a) Gender / Élève a) Sexe*
Male Female
Student b) Gender / Élève b) Sexe
Male Female
OTHER/AUTRES
Student a) Age / Étudiant a) Âge*
Student b) Age / Étudiant b) Âge
Student a) Height (inches") / Élève a) Hauteur (pouces)*
Student b) Height (inches") / Élève b) Hauteur (pouces)
Student a) Weight (lbs)*
Student b) Weight (lbs) / Élève a) Poids (lb)
part 2 Student a) Divide weight/height / partie 2 Élève a) Diviser poids/taille*
part 2 Student b) Divide weight/height / partie 2 Élève b) Diviser poids/taille
Student a) **CRITICAL** (measure floor to highest point between legs) Inches" TO ENSURE TOP TUBE CLEARANCE ON TRAINING BICYCLE INSEAM (INCHES") / Élève a) **CRITIQUE** (mesurer le sol jusqu’au point le plus élevé entre les jambes) Pouces » POUR ASSURER LE DÉGAGEMENT DU TUBE SUPÉRIEUR SUR L’ENTRAÎNEMENT DU VÉLO INSEAM (POUCES »)*
Student b) **CRITICAL** (measure floor to highest point between legs) Inches" TO ENSURE TOP TUBE CLEARANCE ON TRAINING BICYCLE INSEAM (INCHES") / Élève b) **CRITIQUE** (mesurer le sol jusqu’au point le plus élevé entre les jambes) Pouces » POUR ASSURER LE DÉGAGEMENT DU TUBE SUPÉRIEUR SUR L’ENTRAÎNEMENT DU VÉLO INSEAM (POUCES »)
I*
have included an inseam measurement in INCHES only / ont inclus une mesure inseam dans INCHES seulement will provide an inseam measurement (INCHES only) within the next 24 hours, or I will have to re-apply for another Learn To Ride session / fournira une mesure inseam (INCHES seulement) dans les prochaines 24 heures, ou je devrai postuler à nouveau pour une autre session Learn To Ride
FOR MULTIPLE STUDENTS Please complete add'l information here, B) Name/Gender M,F/Age-yrs/Inseam"/Height' "/Weight-LBS/Pain Factor/ helmet size(s) OR EMAIL DIRECTLY TO info@borntoridebicycle.com wityh subject Learn To Ride w/Your full name / POUR PLUSIEURS ÉTUDIANTS S’il vous plaît compléter add’l informations ici, B) Nom / Sexe M, F / Age-yrs / Inseam"/Taille' « /Poids-LBS / Facteur de douleur / taille du casque (s) OU E-MAIL DIRECTEMENT À info@borntoridebicycle.com wityh sujet Apprendre à rouler w / Votre nom complet
comments/commentaires
I will need / J’en aurai besoin
bicycle(s) for training/vélo(s) pour la formation my bicycle tuned up or serviced prior to session, I will complete a Mobile bicycle service form and make payment for a Tune up (Refer to BICYCLE REPAIRS PAGE) / mon vélo réglé ou entretenu avant la session, je remplirai un formulaire de service mobile de vélo et effectuerai le paiement d’un tune up (Se référer à la PAGE DE RÉPARATION DE VÉLO) to rent additional bicycles for friends and/or family (minimum pre booked 2 weeks prior.)/pour louer des vélos supplémentaires pour les amis et / ou la famille (minimum pré-réservé 2 semaines avant.)
comments/commentaires
I accept / J’accepte*
If I bring my own bike, it has to be in riding condition or there will be additional charges to my account.
Student a) Helmet options*
I will supply my own helmet(s) I will need a helmet(s) 8 years or younger, I will supply helmet
STUDENT a) Helmet size (Teens - Adult)
Small Medium Large
Student b) Helmet options
I will supply my own helmet(s) I will need a helmet(s) 8 years or younger, I will supply helmet
STUDENT b) Helmet size (Teens - Adult)
Small Medium Large
Additional Students information
Why do you feel, you need training?
What motivates you (student) to learn to ride a bicycle?
Choose what best describe Your scenario*
I am a parent frustrated with my childs behavior, not wanting to learn to ride a bicycle I never had the chance to learn to ride a bicycle I had a bad experience, and never went back to riding a bicycle I've been told I don't have the ability to ride a bicycle I feel I must be in control at all times, I have to know the outcome, before I will step out on FAITH. I'd like to enhance my riding skills to a much higher level. Other
Other
I wish to experience
Road Cycling Touring, distance rides using Touring, Hybrid or Road bicycle MTB (Mountain Biking) Touring on distance rides using Hybrid or Road Bicycles Rail trails and manicured pathways Unicycling Cycle within the neighborhood and streets close bye Ride On manicured crushed stone & Paved pathways Mountain bike trails in forests Waterfront trails & pathways Road & Country cycling Ride in City road with traffic Cycling downtown core of city (ie.Torornto) Casual to the park and back Cycle waterfront trails along paved pathways Other
OTHER
HEALTH & WELLNESS
Does the student(s) have a learning disability, mental or physical challenges*
YES NO
Does the Student(s) have any health issues, if yes, you may be required to complete an assessment.**
YES NO
If "Yes" please specify , . Provide links to website, for support on this topic
In preparation for my training session(s), I will complete the following activities sports and/or exercises *
Swimming 2-4 laps within 10 minutes Swimming 3-5 laps within 15 minutes Swimming 5-10 laps within 30 minutes Swimming 10-15 laps within 40 minutes Swimming 15-25 laps or more within 60 minutes I dont know how to swim roller blading I dont how to roller blade Running / jogging 2-5 kilometers within 30 minutes Running / jogging 5-10 kilometers 50 minutes Running / jogging 10-20 kilometers within 100 minutes Running / jogging 20-50 kilometers within 250 minutes Swinging on a swing with no assistance, combined with other outdoor sports for a minimum of 2 hours climbing monkey bars combined with other outdoor sports for 2 hours mountain climbing Climbing trees combined with other high cardio exercise's for 2 hours 1-1/2 hour spinning classes 2 hour spinning classes 3 hour spinning classes walking up and down 4 -6 flights of stairs for 2 hours walking up and down 10-20 flights of stairs for 2 hours walking or hiking 20-40 kms playing basket ball for 2 hours non-stop Soccer for 2 hours non-stop parkour ALL Assigned exercise's mentioned in the Confirmation email other high cardio/intensity sports for 1-1/2-2hours, non stop I DO NOT FALL WITHIN MOST OF THE ASSIGNMENTS ABOVE, AND WISH TO HAVE PRIVATE LESSONS
Other Cardio/intensity
How often will you complete the above sports/exercises prior to your session*
1-2 times/week 3-5 times/week 6-9 times/week 10-12 times/week 13-15 times/week 16-20 times/week other
A. I WISH TO START MY TRAINING IN THE MONTH(S) OF
JANUARY FEBRUARY MARCH APRIL MAY JUNE JULY AUGUST SEPTEMBER OCTOBER NOVEMBER DECEMBER
B. Preferred Day(s)*
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
C. Preferred Time(s) two 2*
4-6am 6-8am 9am-11am 10am-12pm 1-3pm 2-4pm 6-8pm 7-9pm
D. Preferred Dates, Special Requests
1-A I agree to the following*
I realize by completing this form, I accept all risks, inherent injuries, and waive all liabilities and compensations from Born To Ride Bicycle and/or their employees, as well as all organizations/persons that own or manage the lands, that we use for training.
2-B I acknowledge*
We all grow and mature through perseverance, when you make mistakes you learn, when you learn from your mistakes, you develop experience, and become better equipped for life's challenges. In education you learn from others. Other people’s experiences, that they have had made mistakes (trial and error) to attain knowledge. We combine both Experience and knowledge to help you accomplish your goals by taking action. By working with our trainers and having faith, believing you can achieve and actually doing it, you create a higher level of confidence and belief. As you venture more into new experiences, your knowledge and experience accelerates, becoming more successful in life! Eventually you will inspire others to do the same. We look forward to seeing you soon!
3-C I agree to the following*
I do not and will not hold Born To Ride Bicycle or its employees liable for any mental stress or physical injuries. I agree that my trainer has my permission to use any or all techniques and methods to help inspire, motivate, not limited to causing emotional onsets that maybe beyond my comprehension but yield successful results, by encouraging mental growth and developing successful skill sets, in the form of becoming a cyclist and a stronger personality. We define this as strong leadership skill.
4-D I realize*
When raised in certain environments that lack discipline and/or expectations, or if a student spends any time in a online virtual world (gaming, social media); there mindset and perceptions will heighten levels of stress outside of that environment due to poor real life experiences, and will create disconnection from family members, limited flexibility, adaptability to change inability to control their emotions and can even result in similar characteristics to drug addiction. And if not corrected early can result in weak will power over come life’s everyday challenges, and/or mental breakdown in some form.
5-E I accept that*
Under extreme scenarios to help the student grow, we may trigger the student to experience emotional onsets, that help the student release stressors getting over certain stumbling blocks, that help them mature, and in other rare scenarios the student can be very stubborn not willing to accept their present environment, and in most cases we will need to extend the number of training sessions, and there intensity, sometimes with the help of the parent(s) putting barriers or restrictions in place to change the students behavior’s, before, during and after each session.
6-F I acknowledge:*
To successfully move forward, your trainer will expect performance and consistent improvements and adaptability, or he will have no choice but to increase the number of sessions to suit the student’s learning curve, with the goal of yielding results.
7-G I accept that*
Our trainers encourage perseverance, are very patient, 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
comments