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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