2018 Bike Rodeo Registration
Use this form to register your children for the Bike Rode August 18th from 2 to 4pm.
Email address *
Parent / Guardian Last Name *
Jordan
Your answer
Participant(s) Age 12 and under First Name(s) *
Aaron, Moses & Zippy
Your answer
Parent(s) / Guardian(s) First Name *
Abraham and Sarah
Your answer
Participant(s) Last Name *
Jordan
Your answer
Gender
Child 1 - Boy, Child 2 - Boy, Child 3 - Boy, Child 4-No More Eligible Children
Boy
Girl
No More Eligible Children
Child 1
Child 2
Child 3
Child 4
Child 5
Child 6
I
Child 1- 3 years, Child - 2-3rd grade, 4-K, Child 3 - 5th grade, Child 4- No More Eligible Children
3 years
4-K
1-2 grade
3-4 grade
5-8 grade
No more children
Child 1
Child 2
Child 3
Child 4
Child 5
Child 6
Address
131 Rodeo Drive
Your answer
540-241-1111
Your answer
540-421-1111
Your answer
Allergies
None, but Zippy has an inhaler
Your answer
Medical
None
Your answer
Emergency Contact
Eve Johnson
Your answer
Emergency Contact Phone
540-470-1111
Your answer
Relationship to the child
Grandmother, referred to as Nanny; Grandfather, referred to as Grams.
Your answer
Please list T-Shirt sizes
youth medium, youth medium, youth small, youth small
Your answer
Please list Helmet sizes
Extra-small: below 20" (51cm)Small: 20"–21.75" (51cm–55cm)Medium: 21.75"–23.25" (55cm–59cm)Large: 23.25"–24.75" (59cm–63cm)Extra-large: above 24.75 (63cm)
Your answer
Kid's Date of birth (mm/dd/yyyy)
12/11/2009, 08/27/2011, 03/21/2014, 04/16/2015
Your answer
Additional Comments
We have an extra bike if someone needs one, and we need a extra small helmet.
Your answer
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