Learn to Ride Parent Registration

You Can Ride 2

Your registration has been successfully submitted.

Does your child want to learn to ride a two-wheeled bicycle? *

Yes

No, I wanted to borrow an adaptive bicycle

Who is filling out this form? *

Do you have (or are you willing to obtain) a 2 wheeled bicycle that your child can use for the duration for the course? *We are not able to supply bicycles for this program.

Yes

Do you feel that you just need a few tips to get your child going (e.g., your child may not need a full 6 lessons to master riding)? *(at this time, you will be asked to sign a waiver and pay a $100 refundable deposit)

Yes

Please note: only those that do attend will be guaranteed their place in line

Are you available for 6-8 Thursdays beginning at the end of April 2024? *Classes run from 6-7 pm or 7-8 pm, depending on your child's needs.

Yes

We are sorry, you are not eligible for the Learn to Ride program. If you have questions, please contact us at ycr2@edmontonbikes.ca

If you would like to borrow an adaptive bicycle instead, please click here.

Has your child been part of a You Can Ride 2 program before? *

Yes

Therapist Information

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

First Name: *

Last Name: *

Discipline:

E-Mail:

Phone Number:

Registration Information (Child)

Child's first name: *

Child's last name: *

Date of birth: *YYYY-MM-DD

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): *

Relationship to Participant: *

Parent/Guardian 1

Same as Primary Contact

First Name: *

Last Name: *

Address: *

Home Phone: *

Cell Phone: *

E-Mail: *

Parent/Guardian 2

First Name:

Last Name:

Address:

Home Phone:

Cell Phone:

E-Mail:

Alternative Pick-up

Will anyone other than legal guardian be dropping off/picking up your child? *

Yes

First Name of person picking up: *

Last Name of person picking up: *

Phone: *

Emergency Contact

First Name: *

Last Name: *

Relationship: *

Home Phone: *

Cell Phone: *

Allergies

Does your child have any allergies? *

Yes

Please specify all of your child's allergies: *

Medical Diagnosis Information

Does your child have a diagnosis that may affect their participation in cycling? *(i.e., Asthma, Developmental Coordination Disorder, Cerebral Palsy, Diabetes, ADD, Anxiety, etc.)

Yes

Please specify diagnoses: *

Do you know of any reasons why your child should not participate in physical activity? *

Yes

Please specify: *

Does your child have any behavioral concerns?

Yes

If your child has behavioural concerns, would you be able to provide a support worker to help with your child's behavior?

Yes

Social Worker

First Name:

Last Name:

Phone Number:

E-Mail:

Additional Information

Is your child on any medication that may impact their cycling? *(e.g., seizure medication)

Yes

Please specify all medication:

Please list any other information that may affect your child's ability to learn how to ride a bicycle:(i.e., learning disability, behaviours, language delay, cognitive delay)

Background Information

Please indicate your child's ability in the following areas:

Pedalling a tricycle/bike with training wheels: *

Stopping using brakes: *

Steering around corners: *

How long have you been working on riding a two wheeled bike? *

Which strategies have you tried when teaching your child to ride? *(e.g., running beside the bike, taking off pedals, other biking groups, gyrowheel)?

What do you feel are the biggest issues that are making bike riding difficult for your child? *(e.g., fear of falling, tires easily, distractibility, poor balance, etc.)

On a scale of 1 to 10, how important is it to you that your child learn to ride a two-wheeler?

1 = Not at all important

10 = Extremely important

On a scale of 1 to 10, how important do you think this skill is to your child?

1 = Not at all important

10 = Extremely important

How would you rate your child's CURRENT performance when riding a two-wheeled bicycle?

1 = Unable

10 = Proficient

How would you rate your SATISFACTION with your child's bike riding abilities on 2 wheels?

1 = Unsatisfied

10 = Extremely satisfied

Are there any strategies that might help us help your child to learn this skill? *(e.g., reward strategies, strong interests that help with motivation, skills they are particularly good at)

Where will your child be riding?e.g., on the sidewalk only, on trails, on the roads

Please note that the information you provide 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. If you have any questions, please contact us at YCR2@edmontonbikes.ca.