2017 Ride For Santa Registration Form
Please Complete Form for Each Child You Are Registering
Child's Name *
Your answer
Child's DOB *
MM
/
DD
/
YYYY
Parent's Name *
Your answer
Parent's Phone Number *
Your answer
Parent's Email Address *
Your answer
Will the Child Be Bringing a Bike to Ride or Ride a Bike Provided By Little Miracles? *
How Many People Will Attend the Event With the Child? *
Your answer
If You Plan To Register More Than 1 Child, Please List Other Children's Names Here (in addition to filling out registration forms for each child)
Your answer
Questions/Comments/Concerns
Your answer
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