REGISTRATION LEARN TO RIDE

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

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.

By completing this form, you are Helping us understand 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.

I have MEASURED the students INSEAM from the HIGHEST point between legs to floor, in INCHES"

I will use the Imperial system, providing measurements in Feet, inches and LBS to complete this form

1.0**** FULL NAME OF PERSON PURCHASING TRAINING*

E-Mail Address*

1.1 I am the *

Other

1.2 **** If we need to call you, what Days/Hours are best.*

1.3 I will be attending the training*

	YES
	NO

2.0 If " NO ", Provide CUSTOMERS ____F U L L___ N A M E attending with student

2.1. RELATIONSHIP OF CUSTOMER ATTENDING THE TRAINING IS THE*

other

2.2 DAY OF TRAINING CONTACT PERSON*

2.3 CELL# PHONE TO CALL/TEXT*

2.4 Contact person Address ( # Street )*

2.5 City, Country, Postal/Zip Code*

3. STUDENT(s)___F U L L____ N A M E(s) requiring the training*

4.0 **** SELECT A LOCATION FOR TRAINING*

4.1 OTHER preferred Ontario Locations FOR ASSISTANCE CALL: 1-855-795-4482

5. **** CATEGORY OF INTEREST select more than one

	98% TRI-TRAINING PKG 2hr 1st time + two 1-1/2hr sessions, Private (offers 1st time through 3rd level training)
	99% MOMENTUM PKG 1-30 MIN + 1-2HR 1ST TIME + FOUR 1-1/4 HOUR S'SSN (gradual progression, office/indoor types)
	98% Children PKG 1-2 HR + FIVE 1-1/4HOUR S'SSNS
	99% TLC PKG 1-30MIN+1 1-1/2HOUR+6 1-1/4 HOUR S'SSNS
	ACTIVE-REBOUND PKG 14 CONSEC. 45 MIN./DAY
	ACTIVE-REBOUND PKG 7 CONSEC. 1-1/2 hrs/DAY
	ACTIVE-REBOUND PKG 7 CONSEC. TWO X 45MIN./DAY
	ACTIVE-REBOUND PKG 6 CONSEC. TWO X 45MIN./DAY
	ACTIVE-REBOUND PKG 6 CONSEC. 1-1/2 hr/DAY
	FAST TRACK 1 DAY PKG 30 MIN.+ 2HR+1-1/2HR S'SSN
	FAST TRACK 2 DAY PKG 30 MIN.+ 2HR+1-1/2HR S'SSN
	3 hour Two Students L-Ride session 1hr/student +1hr combined
	CYCLE SAFETY CrossX-Trng 30MIN. PRE-TEST + 3DY-B-RTL + 3 -2 HR SESN's
	KICK START 2HR + 1HR FOLLOW-UP (USE THE TWO STDT 3HR L-RIDE PAYMENT OPTION)
	1st time 2hr Learn To Ride Private session (mandatory for 1st time students, unless a package is selected)
	2nd level 1-1/2hr Learn To Ride Private session (available after 1st time training)
	3rd level Learn To Control your bicycle, 2hr Learn To Ride Private session
	4th level Learn To Avoid & Overcome Obstacles
	5a level Learn Styles of Cycling, SIX Categories of Bicycles
	5b level learn what is my style of riding & what bicycle should I Purchase
	6th level Learn to make the transition from L-Ride to Riding my new bicycle
	7th level Learning the basic mechanics and servicing of my bicycle
	8th Riding different terrains and interpreting surface areas for riding safely
	9th Riding with traffic
	July 2nd - 30th, 2 for 1 Deal: 2hour + 2 hour sessions for the price of one, complete within 24 hours from start date.
	CYCLE SAFETY TRAINING (Cross Training All Terrain + Road)
	SAFE CYCLE CERTIFICATION for riding the roads
	ASSESSMENT of Your Skills sets & abilities to Ride (30-45 MIN. SESSN)
	ASSESSMENT PKG 30 MIN + 2HOUR SESSN
	Advance Your Skills, 2 hour Session
	Semi-Private Lessons
	INTRODUCTION TO MOUNTAIN BIKING (expect to travel, to designated locations)
	Learn the basics: shifting gears, removal and assembly of wheel and bicycle in/out of vehicles
	We Come To You, Learn To Ride Training
	Other training

6.0. For best results *

I realize it's CRITICAL, that my 1st two training sessions ARE booked no more than 24-48 hours apart, unless it is in preparation to getting started or an Assessment

6.1. I WISH TO START MY TRAINING IN THE MONTH(S) OF

	JANUARY
	FEBRUARY
	MARCH
	APRIL
	MAY
	JUNE
	JULY
	AUGUST
	SEPTEMEBR
	OCTOBER
	NOVEMBER
	DECEMBER

6.2 DAYS OF THE WEEK (preferred days for training)*

	Sunday
	Monday
	Tuesday
	Wednesday
	Thursday
	Friday
	Saturday

6.3 START TIMES (best times for training)

	6 AM
	9 AM
	10 AM (subject to approval)
	12 PM
	3 PM
	5 PM (subject to approval)
	6 PM
	9 PM
	10 PM (Adults only)
	other DATE/TIMES

Other dates/times

7.0 **** F U L L____N A M E of Customer attending the training*

7.1 Alternative Customer Phone#

7.2 . CUSTOMERS OCCUPATION/FACULTY/INDUSTRY*

7.3 YOUR, Pain Factor (skip, if you are the STUDENT)

Other

7.4 CUSTOMER (skip, if you are the STUDENT)

	YES, I KNOW HOW TO RIDE A BICYCLE
	"NO, I DO NOT KNOW HOW TO RIDE A BICYCLE "

7.5 HOW DID YOU LEARN TO RIDE ?

8.0 Date AND DESCRIPTION of last training session (if applicable)

9. ONE OF TWO SCENARIOS*

Takes place: SCENARIO 1. The student, successfully learns to ride a bicycle within the 1st session, realizing they now can ride, they are excited but still nervous, Asking there trainer “HOW DO I CONTROL THIS THING ?” “How do I prevent myself from hitting a car or pedestrian. More training is requested. SCENARIO 2.The Student is not successful in the 1st session, but succeed after additional training, due to weak core, lack of understanding, no previous skill sets, history of personal hurdles to overcome. Because of this we created discounted training packages, offering a 98% success rate. Most of our clients, request add'l sessions. To ensure success, pre-book your 2nd session, within 24-48 hours from your 1st. If you wait till after your 1st session, you may Wait 2-3 weeks to be scheduled in, then you will spend additional training time reviewing what you learned already with less confidence, when you could have been advancing and learning new techniques and strengthen core gr

10.0 A)**** Student__A____F_U_L_L NAME*

10.1 A) OCCUPATION/FACULTY/INDUSTRY*

10.2 A) Pain Factor*

10.3 A)*

	Male
	Female

10.4 A) Age*

10.5 A) WEIGHT (LBS)*

10.6 A) HEIGHT (INCHES)*

10.7 A) ***CRITICAL____Top tube clearance* Please Measure from floor to highest point between legs (inches) INSEAM *

10.8 A) Helmet (Teens - Adult)*

10.9 A) BICYCLE(s) options*

	I will need to rent a training bicycle(s), to take home and practice between my sessions and at the end of the rental duration I agree to: a) Return bicycle either on my last training session, b) I will pay pick-up/delivery charges, c) I will return bicycle(s) at my cost to storage facilities in Innisfil(Barrie) or Wellesley.
	I will need a bicycle tuned up or serviced prior to session, REFER TO BICYCLE REPAIR PAGE on website
	I will need additional bicycles for friends and/or family
	I will require a bicycle to practice on after all my training is complete (most students rent from 1-3 months) and at the end of the rental duration I agree to: a) Return bicycle either on my last training session, b) I will pay pick-up/delivery charges, c) I will return bicycle(s) at my cost to storage facilities in Innisfil(Barrie) or Wellesley.
	NA

10.10 A) HEALTH ISSUES Does the Student(s) have any health issues: physical and/or Learning Disabilities, mental disorders/challenges etc.. if yes, you may be required to complete an assessment.*

	YES, I WILL SPECIFY BELOW.
	NONE. THE STUDENT HAS NO HISTORY OF HEALTH ISSUES, THAT WOULD PREVENT THEM FROM PERFORMING ALL PHYSICALLY OR MENTALLY ASSIGNED EXCERCISES / FUNCTIONS IN THE TRAINING TO LEARN TO RIDE A BICYCLE.

10.11 A) If YES, please specify

11. MORE than one student is been trained*

	YES
	NO

12.0 Student__B____F_U_L_L NAME

12.1 B OCCUPATION/FACULTY/INDUSTRY

12.2 B Rank your Pain Factor

12.3 B

	Male
	Female

12.4 B AGE

12.5 B WEIGHT IN POUNDS (LBS)

12.6 B HEIGHT IN INCHES

12.7 B INSEAM MEASUREMENT "CLEARANCE" highest point between legs to floor in INCHES

12.8 B HELMET SIZE (TEENS-ADULT)

Other

12.9 B HEALTH ISSUES Does the Student (B) have any health issues, physical and/or Learning Disabilities, mental disorders/challenges etc.. if yes, you may be required to complete an assessment.

	YES, I WILL SPECIFY BELOW.
	NONE. I HAVE NO HISTORY OF HEALTH ISSUES, THAT WOULD PREVENT ME FROM PERFORMING ALL PHYSICALLY ASSIGNED EXCERCISES AND MENTAL FUNCTIONS IN THE TRAINING TO LEARN TO RIDE A BICYCLE.

12.10 B If "Yes" please specify, also include a link that best explains your issues

13. A D D I T I O N A L STUDENTS Please complete add'l information here, or email to info@borntoridebicycle.com with: Name/Gender M,F/Age-yrs/Inseam"/Height' "/Weight-LBS/Pain Factor/ helmet size(s)

14. **** What is your Scenario, SELECT more than one *

	I am a parent frustrated with my child's behavior, not wanting to learn to ride a bicycle
	I never had the chance to learn to ride a bicycle
	I refused to learn as a child
	My parents didn't take the time to teach me
	It was not acceptable within my cultural/family background
	I had personal limitations, that prevented me from having 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.
	Part of my Bucket list
	Regret I never learned to ride a bicycle
	I'm excited about learning to ride a bicycle!
	I live a very academic life
	A social/domestic oriented type, books, art, music
	Spend most of my time in a office environment
	Reluctant to learn at a young age
	SPORTS ENTHUSIASTS, SWIMMING, SKING, RUNNING/JOGGING, SOCCCER, BASEBALL, FOOTBALL ROLLER BLADING ..ETC.
	I'M AN OUTDOOR TYPE, ALWAYS OUT THERE WORKING OUT, PHYSICALLY FIT
	I LIVE A VERY ACTIVE LIFE
	Lack of confidence
	Lazy, never took the time
	Because, I never learned to ride, I need help teaching someone to ride
	Motivated, but dont have the right teacher or techniques to learn
	Friends/family tried, no luck
	Had/have no patience, other interests
	No patience to teach, need help
	High anxiety type, get easily stressed
	No time, NOW THAT I'M OLDER I WANT TO LEARN
	Stubborn/rebel against Authoritative figures/parents NOT WILLING TO LEARN
	Spends most of time cooped up in room on gaming or social media
	Grew up in the wrong environment with nowhere to safely ride
	Disciplined by parents who shaped my life
	Forbidden, wasn't allowed to ride a bicycle
	Due to previous experience(s), I wish to learn safe cycling practices
	Down Syndrome, mental or physical chlllenging issues (caregiver or parent to assist)
	Recoverying from accident or surgery
	Other/comments

OTHER/COMENTS

15. I wish to cycle*

	within the neighborhood and streets close bye
	on manicured crushed stone & Paved pathways
	Mountain bike on forests trails
	paved & Country roadways
	in City traffic
	downtown core of city (ie. Toronto)
	casual to the park and back
	waterfront trails along paved pathways
	and learn more advanced cycling skills
	Road
	MTB (mountain Biking)
	Touring, distance rides using Touring, Hybrid or Road bicycle
	Rail trails and manicured pathways
	Waterfront trails & pathways
	I Will need help with deciding my style

16. ARE YOU MOTIVATED? WHY OR WHAT MOTIVATES YOU to Learn To Ride a Bicycle ?

17. **** YOUR LEVEL OF COMMITMENT To ensure my success and improve my level of fitness, I will*

	independently Swing, and will practice swinging on a swing
	do all Assigned exercises mentioned in my Confirmation email,
	teach myself how to overcome my fears
	climb monkey bars with other outdoor cardio activities for 2 hours
	play in the park on all the recreational equipment for 2 hours
	understand the principles of how to swing on a swing
	learn how to swing on a swing, before my 1st training session
	practice jumping off a ledge with both feet together, 3 to 6 times in succession
	complete extensive 2-4 hours walks or hiking experiences
	complete 3 sets of ten push ups lifting my own body weight in succession
	jump into a swimming pool with both legs tight to my chest to create a cannonball splash in the water
	Participate in competitive sports activities
	Swim 2-4 laps within 10 minutes
	Swim 3-5 laps within 15 minutes
	Swim 5-10 laps within 30 minutes
	Swim 10-15 laps within 40 minutes
	Swim 15-25 laps or more within 60 minutes
	roller blading
	Run/jog 2-5 kilometers within 30 minutes
	Run/jog 5-10 kilometers 50 minutes
	Run/jog 10-20 kilometers within 100 minutes
	Run/jog 20-50 kilometers within 250 minutes
	get in some mountain climbing
	Climb trees for 2 hours to increase my endurance
	ride in 1-1/2 hour spinning classes
	ride in 2 hour spinning classes
	ride in 3 hour spinning classes
	walk up and down 4 -6 flights of stairs for 2 hours
	walk up and down 10-20 flights of stairs for 2 hours
	walk or hiking 20-40 kms
	play basket ball for 2 hours non-stop
	play soccer for 2 hours non-stop
	do Parkour
	complete high cardio/intensity sports for 1-1/2-2hours, non stop
	most of the above does not apply to my circumstance, I will require lots of TLC.

18. How often will you train for? (above mentioned exercises prior to your session(s)?

	1-2 times/week
	3-5 times/week
	6-9 times/week
	10-12 times/week
	13-15 times/week
	16-20 times/week
	greater than 25 times/week

19. *

	As a part of stimulating core muscle groups and been a 1st time Student, I will practice Swinging on a swing (with no assistance), combined with other outdoor athletic sport activities.
	I have completed my 1st time training session

20.

	AFTER I complete my trainiing, I would like to be matched up with a Cycling Buddy (SEE CYCLE BUDDY Page)
	NA

BICYCLE OPTIONS

21.0 SELECT What best suits you*

21.1 Bicycle purchasing Budget

21.2 Purchase comments

21.3 Bicycle Purchase *

	Based on my trainers recommendations I would like Born To Ride Bicycle to source out a bicycle for me, and if possible arrange delivery and custom fitting to my recommended size, I agree to pay a 10% surcharge for this service, plus any additional training time required to help me adapt to my bicycle.
	I will source out my own bicycle, based on my trainers recommendations
	NA

COMMENTS

DISCLAIMER/REQUIREMENTS*

I the parent and/or student, is of legal age, and have truthfully provided the status of my or the students both mental and physical health, on my/there behalf and acknowledge that, if found that you have not provided full disclosure or falsified information or mislead your trainer, in any way, you will forfeit all moneys paid for training sessions, with no recourse or refund. Not limited to requiring to provide a doctor’s note as proof the student(s) is in good mental and physical health to proceed with the training. If falsified information has been provided all training will expire within same calendar year of commencement and/or purchased from, and will be subject to management’s review, to void all training.

66. ACKNOWLEDGEMENT OF INSEAM*

67. SUCCESS*

Success is not built on convenience nor comfort, be committed to your goals and willing to break outside of your comfort zone, make changes, you will be expected to adapt to many changes, and experience discomfort, to successfully ride a bicycle.

ACKNOWLEDGEMENTS/AGREEMENTS

68. I accept*

If I bring my own bicycle, it has to be in riding condition or there will be additional charges to my account.

69. 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.

70. 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!

71. 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.

72. I realize *

When raised in certain environments that lack of 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 lack of 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 to overcome life’s everyday challenges, and/or mental breakdown in some form.

73. 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.

74. 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.

75. 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.

76. I*

have submitted accurate HIEGHT, WEIGHT, INSEAM Measurements in feet, inches and pounds (lbs.) Not in metric