LTR Reservation Ottawa-Gatineau-Halifax Please note that all fields followed by an asterisk must be filled in. Training Location*
---Select--- 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 Park, Quebec 15 km North of Ottawa
GATINEAU Park, Quebec 15 km North of Ottawa, if there no availability here , I will come to Nepean Ontario, 15 km South of Ottawa
Other Location, with this option I will provide a location that meets Born To Ride Bicycle's REQUIREMENTS
Halifax Nova Scotia
Dartmouth Nova Scotia
ADDITIONAL TRAINING CITIES LIMITED DATES/TIMES (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
CORNWALL - STUDENT PROVIDES LOCATION
CUSTOMER, First and Last Name*
Last Name*
Cell Phone 1-*
Alternative Phone 1-
E-Mail Address*
Street Address
City and Zip/Postal Code*
Best days & hours to Call you (example: Mon 2:30 AM - 11:45PM)*
1. Cell Phone# on the day of the training?
2. Student(s) Full Name** I agree to provide * Students Gender* 3. Student(s) 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
I* Additional students 7. Type of Training* 8. Other training 9. Preferred dates 10. Dates, Special Requests 11. Day(s) of week preferred 12. Preferred Time(s) of Training (give 2) 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? 21. I wish to experience 22. I wish to CYCLE 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 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* comments