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Bike Path Learning Registration
Please fill out ONE form PER child.
Email address *
Child's School *
Child's First & Last Name *
Your answer
Grade *
Payment Option
Language interested in learning *
Please explain language experience *
Your answer
Is the child enrolled in a Before and or After School Program? *
Does your child have permission to walk home? *
Please list any allergies, special needs or concerns *
Your answer
Your First and Last Name *
Your answer
Relationship to the child *
Email *
Your answer
Cell number xxx-xxx-xxxx *
Your answer
Home number xxx-xxx-xxxx
Your answer
Other person we are allowed to call *
Your answer
Secondary contact's cell number *
Your answer
Address *
Your answer
Are you a staff member at any school? *
Questions or Comments?
Your answer
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