Borrow an Adaptive Bike
Parent Registration

Wood Buffalo You Can Ride 2

Your registration has been successfully submitted.

Do you live within the Wood Buffalo area? *

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 wbyoucanride2@gmail.com

The following restrictions apply:

under 19 years of age
in Wood Buffalo or surrounding area
must have parent/guardian approval

Registration Information (Child)

Child's first name: *

Child's last name: *

Child's date of birth: *

Grade: *

School: *

Child's diagnosis *

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: *

Registration Requirements

Please read carefully and check off ALL requirements if you agree:

I understand that the parent/guardian MUST accompany the child to the fitting OR send a completed waiver form with a representative.

I understand that I am responsible for providing a helmet (helmet must be brought day of bike fitting) and a clean/dry secure place to store the bike.

I understand I will be charged a $75 rental fee per season.

I understand that the bike is on temporary loan and I will be responsible for returning it at the end of the loan period by a specified day.

I understand that I will be charged for the replacement or repair of any items lost/ damaged and will be responsible for the full cost of the bicycle if it is not returned.

I agree to participate in a short survey at the end of the program

I give permission for Wood Buffalo You Can Ride 2 to contact those I list on this registration form for information about my child as it relates to matching my child with the best bike for his/her needs.

I understand that Wood Buffalo You Can Ride 2 may also approach these contacts if I fail to return the bike by the deadline stated.

Borrow an Adaptive BikeParent Registration

Borrow an Adaptive Bike
Parent Registration