Pedal Positive Individual Instruction Request for ADULT/TEEN LEARN TO RIDE and BASIC RIDING SKILLS PRACTICE
Thank you for your interest in Pedal Positive individual instruction! This is a $150 value that we provide as a free service to help folks in the community. Free individual instruction is provided ON A CASE-BY-CASE BASIS for adults/teen 13 years of age and up (with some exceptions). Please complete this request form and we'll follow up with you as soon as possible.

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INDIVIDUAL AND PRIVATE GROUP INSTRUCTION OPTIONS
Pedal Positive has two great options available! Both are free, and bikes and helmets are included:

(1) ADULT/TEEN LEARN TO RIDE - INDIVIDUAL INSTRUCTION:
This FREE 2-hour class is for adults and mature teens (13 and up) who want to learn how to ride a bicycle in a fun, supportive environment. Class size is limited to allow students to receive personalized instruction. Our friendly certified instructors use a safe, easy, and successful method to teach students how to balance, pedal, start, stop, and steer a bike. Some people learn to ride in one session. But, if not, you can come back for as many free sessions as you need or use the low-stress method you’ll learn to teach yourself!

(2) ADULT/TEEN BASIC RIDING SKILLS PRACTICE - INDIVIDUAL INSTRUCTION:
This FREE 2-hour open format practice session is for recent Learn to Ride graduates or others who know how to ride but need to work on their basic handling skills in a fun, supportive environment. The session is led by a friendly certified instructor and allows participants to practice using one of Pedal Positive’s bikes (or bring your own in good working order) and ask the instructor questions and receive tips, as needed.

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GENERAL INFO FOR BOTH OPTIONS:

CLASS DURATION:        2 hours
CLASS LOCATION:        Flexible
CLASS TIME:                  Flexible (typically 2-hour block on weekend between 9AM - 2PM)
AGE LIMIT:                      Students must be at least 13 years old (some exceptions on case-by-case basis).
EQUIPMENT:                  Bicycles and helmets are included with registration. May bring your own bike in good working order.
WHAT TO BRING:          Wear comfortable clothes and bring water and snacks.
Student First Name *
Student Last Name *
Parent/Guardian First Name (If applicable)
Parent/Guardian Last Name (If applicable)
Phone Number *
City *
State *
Emergency Point of Contact Name *
Emergency Point of Contact Phone Number *
Which type of instruction are you requesting? (Select One) *
What is the student's riding experience? *
What are your riding goals for this session? *
Preferred DATE? NOTE: We'll finalize after receiving your request. *
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The class will be conducted in Alexandria, VA (exact location finalized after receiving your request.). Please confirm that this is amenable. *
Preferred TIME (2-Hour block)? NOTE: We'll finalize after receiving your request. *
Student Height (e.g. 5'7")? For bike sizing *
Student Gender *
Student Age? *
Need a Bike? *
Need a Helmet? *
How did you hear about Pedal Positive? *
Required
Who referred you? ("N/A" if not referred) *
PEDAL POSITIVE RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AND CONSENT AGREEMENT
I've read and agree to the Pedal Positive liability waiver at http://waiver.pedalpositive.org. If I or any other registrants are UNDER 18, I will have the parent/guardian complete the YOUTH WAIVER form at http://youthwaiverform.pedalpositive.org. *
A copy of your responses will be emailed to the address you provided.
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