REGISTRATION LEARN TO RIDE USA

Learn to Ride in the USA. Fill out the reservation form to select your location, date preference and type of training......

This Form cannot be submitted until the missing fields (labelled below in red) have been filled in
Please note that all fields followed by an asterisk must be filled in.
1. FULL NAME OF PERSON PURCHASING TRAINING (Parent, Student, Freind...etc.)*
2. For standardization,*
I will use the Imperial system, providing measurements in Feet, inches and LBS to complete this form
SELECT LOCATION
---Select---DETROIT MICHIGAN USA TRENTON MICHIGAN USA FORT LAUDERDALE FLORIDA HOLLYWOOD FLORIDA MIAMI FLORIDA PLANTATION FLORIDA PEMBROKE PINES FLORIDA MIAMI FLORIDA NEW YORK NIAGARA FALLS USA
4. Other locations. FOR ASSISTANCE CALL: 1-855-795-4482
5. CATEGORY OF INTEREST
98% success TRI-TRAINING PKG 2hr 1st time + two 1-1/2hr sessions, Private (offers 1st time through 3rd level training) 99% success MOMENTUM PKG 1-30 MIN + 1-2HR 1ST TIME + FOUR 1-1/4 HOUR S'SSN (gradual progression, office/indoor types) 99% success TLC PKG 1-30MIN+1 1-1/2HOUR+6 1-1/4 HOUR S'SSNS 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 CYCLE SAFETY TRAINING (Cross Training All Terrain + Road) ASSESSMENT of Your Skills sets & abilities to Ride (30-45 MIN. SESSN) Advance Your Skills, 2 hour Session Learn the basics: shifting gears, removal and assembly of wheel and bicycle in/out of vehicles Other training
6. I WISH TO START MY TRAINING IN THE MONTH(S) OF
JANUARY FEBRUARY MARCH APRIL MAY JUNE JULY AUGUST SEPTEMEBR OCTOBER NOVEMBER DECEMBER
7. For best results *
I realize my 1st two training sessions should be booked no more than 24-48 hours apart, unless it is in preparation to getting started or a 1/2hr intro/Learn to Ride Package
8. DAYS OF THE WEEK*
Sunday Monday Tuesday Wednesday Thursday Friday Saturday
9. START TIMES
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) ALTERNATIVE DATE/TIMES
10. ALTERNATIVE DATE/TIMES
11. DAY OF TRAINING CONTACT CELL# PHONE CALL/TEXT*
12. Days/Hours to Call*
13. 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.
14. CUSTOMER is the*
---Select---STUDENT SPOUSE PARENT GUARDIAN GRANDPARENT AUNT UNCLE NEPHEW NIECE FREIND SPONSOR DISTANT RELATIVE OTHER; DETAILS BELOW
15. CUSTOMER___ F U L L____N A M E*
16. CUSTOMERS OCCUPATION/FACULTY/INDUSTRY*
17. Alternative#
18. Address (#, Street, city,state, country, zip code)*
E-Mail Address*
19. CUSTOMER, Pain Factor (LEAVE BLANK, if you are the STUDENT)
---Select------------------------------------------- I’m constantly taking pain killers I fall apart at the first onsite 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 and 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 Lifes Full Of Risks, And I’m willing take it all on! No Comment
20. *
YES, I KNOW HOW TO RIDE A BICYCLE "NO, I DO NOT KNOW HOW TO RIDE A BICYCLE "
21. , HOW DID YOU LEARN TO RIDE ?
22. Date/Type of last session (if applicable)
23. ONE OF TWO SCENARIOS*
Takes place with each of our students A) The student successfully learns to ride a bicycle within the 1st 2 hour session, realizing they can now ride, but “HOW DO I CONTROL THIS THING?!” “How do I prevent myself from hitting a car or pedestrian. So more training is requested. B) They’re not successful in the 1st session, but succeed after additional training, due to weak core, lack of understanding, no previous skill sets and/or previous 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 til after your 1st session, you may Wait 1-2 weeks to be scheduled in, then you may spend additional 45 minutes reviewing the last session, when it could have been spent on new techniques and strengthen core issues. Save yourself time and money, and purchase a training package. now, to ensure your
24. STUDENT A F_U_L_L NAME*
25. A) OCCUPATION/FACULTY/INDUSTRY*
26. A) Pain Factor*
---Select---I’m constantly taking pain killers I fall apart at the first onsite 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 and 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 Lifes Full Of Risks, And I’m willing take it all on!
27. A)*
Male Female
28. A) Age*
29. A) WEIGHT (LBS)*
30. A) HEIGHT (INCHES)*
31. A) DIVIDE WEIGHT/HEIGHT (LBS/INCH)*
32. A) MY WEIGHT TO HEIGHT RATIO IS*
BELOW 2.0 BETWEEN 2.0 AND 2.25 ABOVE 2.25
33. A) Multiply 2.15 x your height in inches, this would be your trainers weight at your height
34. A) ***CRITICAL***Top tube clearance* Measure highest point between legs to floor (INCHES) INSEAM *
35. A) Helmet (Teens - Adult)*
---Select---S Helmet M Helmet L Helmet XL Helmet No Helmet required, I will supply my own student is 8 years or younger, I will supply my own helmet
36. 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
37. 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.
38. A) If YES, please specify
39. STUDENT B F_U_L_L NAME
40. B) OCCUPATION/FACULTY/INDUSTRY
41. B) Rank your Pain Factor
---Select---I’m constantly taking pain killers I fall apart at the first onsite 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 and 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 Lifes Full Of Risks, And I’m willing take it all on!
42. B)
Male Female
43. B) ENTER AGE
44. B) ENTER WEIGHT IN POUNDS (LBS)
45. B) ENTER HEIGHT IN INCHES
46. B) DIVIDE WEIGHT/HEIGHT (LBS/INCH)
47. B) MY WEIGHT TO HEIGHT RATIO IS
BELOW 2.0 BETWEEN 2.0 AND 2.25 ABOVE 2.25
48. B) Multiply 2.15 x your height in inches, this would be your trainers weight at your height
49. B) INSEAM MEASUREMENT "CLEARANCE" highest point between legs to floor in INCHES
50. B) HELMET SIZE (TEENS-ADULT)
---Select---S HELMET M HELMET L HELMET XL HELMET No Helmet required, I will supply my own student is 8 years or younger, I will supply my own helmet
OTHER
51. 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.
52. B) If "Yes" please specify, also include a link that best explains your issues
53. ADDITIONAL STUDENTS Please complete add'l information here, B) Name/Gender M,F/Age-yrs/Inseam"/Height' "/Weight-LBS/Pain Factor/ helmet size(s)
54. 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 Other/comments
OTHER/COMENTS
55. 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
56. SELECT What best suits you*
---Select---I wish to be advised on the right fit, size, style of bicycle to ride I wish to purchase a new bicycle and be advised on the right fit, size, style of bicycle to ride I wish to purchase a used bicycle w/seasonal warranty and be advised on the right fit, size, style of bicycle to ride I wish to purchase a Cheap used bicycle for training at home and be advised on the right fit, size, style of bicycle to ride NA
57. ARE YOU MOTIVATED? WHY OR WHAT MOTIVATES YOU to Learn To Ride a Bicycle ?
58. 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 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.
59. How often will you WORK OUT 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
60. *
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
BICYCLE OPTIONS
62. Bicycle purchasing Budget
---Select---$250-350 - used $350-450 - used $450-550 - used (kids new) $550-650 $650-750 $750-850 $850-950 $950-1,050 $1,050-1,150 $1,150-1,250 $1,250-1,350 $1,350-1,450 $1,450-1,550 $1,550-1,650 $1,650-1,750 $1,750-1,850 $1,850-1,950 $1,950-2,050 $2,050-2,150 $2,050-3,050 $3,050-4,050 $4,050-5,050 $5,050-6,050 $6,050-7,050 $7,050-8,050 $8,050-9,050 $9,050-10,050 $10,050-15,050 $15,050-20,050 More than $20,050
63. Purchase comments
64. 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
65. 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.
66. ACKNOWLEDGEMENT OF INSEAM*
---Select---I have MEASURED the students INSEAM from the HIGHEST point between legs to floor, in INCHES" I will provide an inseam measurement (INCHES) within the next 24 hours, or I will have to re-apply for another Learn To Ride session I WILL NOT PROVIDE AN INSEAM MESUREMENT, and Realize INACCURATE or MISSING INFORMATION, WILL LEAD TO INJURIES, FAILURES & POOR RESULTS as oppose to SUPPORTING THE STUDENTS SUCCESS.
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
Please enter the word that you see below.