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Free Dirt Bike Riding Program – Parent Registration Questionnaire

Parent/Guardian Information Full Name:

Email Address:

Phone Number:

Preferred Contact Method:
Phone
Text
Email

Home(ZIP code):

Participant (Child) Information Child's Height:

Child's Weight:

Child’s First/preffered Name:

Age:

Gender:

Riding Experience Can your child ride a 2-wheeled bicycle?
Yes
No

Has your child ridden a dirt bike before?
Yes
No

If yes, please describe their experience level (Beginner, Intermediate, Advanced):

Does your child currently own or have access to a dirt bike?
Yes
No

Health & Accessibility Information Does your child have any special needs or requirements that we need to take into consideration?

How did you hear about the program?
Social Media
Friend/Family
School
Flyer
Other (please specify)

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