Borrow an Adaptive Bike
Parent Registration

You Can Ride 2

Your registration has been successfully submitted.

Are you looking to borrow an adaptive bike (or get help with modifying a bike)? *

Yes

No, I would like to register for the learn to ride course

Do you live within 200 km from Edmonton? *

Yes

Who is filling out this form? *

Waiver forms MUST be signed by the child's guardian or social worker. Will this be possible? *

Yes

We are sorry, you are not eligible to borrow a bicycle through our program. If you have questions, please contact us at info@youcanride2.ca

The following restrictions apply:

under 19 years of age
in Edmonton or surrounding area
must have a therapist referral. If your child is not seen by a therapist, please contact us at info@youcanride2.ca
must have parent/guardian approval

If you would like to register for the Learn to Ride program, please click here.

You Can Ride 2 (YCR2) has opened up Try a Bike Day events for new and returning participants. Most participants who use a wheelchair, walker or who require a high-support bike will try out bikes on Friday January 26, Saturday January 27, or Sunday January 28. Participants who do not use mobility aids will try out bikes on Friday March 8, Saturday March 9 or Sunday March 10. Note: these dates may be subject to change, or you may be invited to attend a different date. Participants who register after these dates may still be able to borrow if bikes are available. Try a Bike Day appointments help determine which bikes/adaptations would best suit your child's needs and usually take around 45 minutes. Attendance at a Try a Bike day is STRONGLY encouraged if you are new to the program, or are looking at trying out a different style of bicycle. If you do not attend Try a Bike Day, there might be delays in when you take the bike home. Will you be attending a YCR2 Try a Bike Day event on one of the dates mentioned above? *

Registration Information (Child)

Child's first name: *

Child's last name: *

Child's date of birth: *

Child's diagnosis *

According to this modified GMFCS scale (see here), my child's rating would be approximately: *

What level best describes your child’s ability to attend to and respond to their environment when cycling? *

Level A: Child's attention levels and understanding of safety situations when on a bike is similar to other children their age.
Level B: Child has some challenges with attention or understanding beyond what would be expected for their age. Child may have a mild to moderate cognitive delay, may be impulsive at times and may not consistently identify situations that may be unsafe. Child generally responds to commands to “stop” and basic directions.
Level C: Child requires significant supervision for all tasks beyond what would be normally expected for their age.

Primary Contact Information

First name: *

Last name: *

Address: *

City: *

Postal Code: *

Home Phone: *

Cell Phone: *

E-Mail (Confirmation e-mail will be sent here): *

E-Mail (Please enter again to confirm): *

Relationship to Child: *

Therapist Information

Please enter details about the therapist who referred you to this program:

First Name: *

Last Name: *

Discipline:

E-Mail:

Phone Number:

I have spoken with my child's therapist regarding biking and choosing an appropriate bike: *

Special Considerations

Families experiencing financial difficulties may be eligible for a subsidy. Click HERE (opens in a new tab) to see if you are eligible.

I believe I would qualify for a low-income subsidy.

All You Can Ride 2 services are provided in English. If you require the services of an interpreter, please let us know.

I request the services of an interpreter.

Language:

Is your family new to Canada?

Do you speak another language other than English?

Yes

What language: *

Do you feel comfortable interpreting in that language for new families to the program as a part of your volunteer commitment?

Yes

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, and allow for the best tracking/monitoring of outcomes. 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.

Borrow an Adaptive BikeParent Registration

Borrow an Adaptive Bike
Parent Registration