Borrow an Adapted Bike Registration Form

Registration Information (Child)
Primary Parent/Guardian Contact Information
Secondary Parent/Contact Information
Check all that apply
(e.g., verbally, alternative/augmentative communication system, can make choices)
(e.g., additional diagnoses, location bike will be used in)
Check all that apply
*on safe trails and with others
What kind of adaptive bike do you have at home?
What didn't work about the bike you previously had (if anything)
e.g. range of movment limitations, leg length discrepancy, transfer considerations etc.
Terms and Conditions for Borrowing a Bike

Volunteer with the organization:

You will be receiving 2 emails - one confirming that you have been successfully registered and one allowing you to select your specific time for your child's bike fitting. Please watch for these 2 emails.

All information provided and generated by staff will be maintained by the organization in order to ensure continuity in the evaluation process for participants in future years, allow for the best tracking/monitoring of outcomes, and remain confidential. Please note that such information may also be maintained for an indefinite period by the organization in anonymized form for general purposes, including in order to allow for program assessment and improvement, allow for research and/or study, and/or grant and financing application purposes.