Please complete the fields below
Name
Please enter your first name and surname
Your answer
Membership Number
Please enter your Wheely Tots Membership number
Your answer
Mobile number
Please enter your mobile number
Your answer
Date of hire and time hire starts from
Please enter the date and time you wish to hire the bike from
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DD
/
YYYY
Time
:
Time you wish to return the bike
Please enter the time you wish the hire to finish
Time
:
Reason for hire
Please summarise what you plan to do with the bike
Your answer
Make a healthy pledge
You can use the bike provided you make a healthy pledge provided you pledge to do a new healthy activity. You can pick an example or add your own)
Required
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