Earn-a-Bike 2019 Registration Form
Please complete this form to register a student for a 2019 Earn-a-Bike program. Once you complete this form and click "submit" we will be in touch to confirm your student's spot in line for a program session. Call with any questions: 269-365-9142!
Students ages 10 to 15 are eligible to be registered and they must commit to attending five of the six sessions Earn-a-Bike sessions in order to earn their bike.
Earning a bicycle at Open Roads is about gaining independence and self-sufficiency, learning how to be active and healthy, having a community to learn and grow with, and feeling safe and supported! *Students ages 16-18 in immediate need of a bicycle for transportation purposes should contact our office at 269-365-9142.
*Full scholarships are available for students who need one. Payment is NEVER a barrier for students who want to participate. Please learn more about this in our "Financial Support" section at the end of this form.
Adult Contact Name (first and last)
Adult Contact PHONE NUMBER
Adult Contact EMAIL (please check this email regularly as this will be a primary form of communication)
Name of Student for Earn-a-Bike program
Age of Student for Earn-a-Bike program
Student Gender Identification
Student Approximate Height (feet, inches)
Scholarship & Fee Options
At Open Roads we welcome any student to participate in programs. We have generous donors who have made a FULL SCHOLARSHIP 100% possible for ANY student. The suggested fee for this six week program is $150. With this knowledge, please indicate the financial support the student(s) you are registering may require:
We require a full scholarship (100%)
We require a partial scholarship and can pay a smaller fee (anywhere from $15 - $135)
We can pay the full fee of $150
(If Applicable) Please explain why your student requires a scholarship to complete this program.:
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This form was created inside of Open Roads Bike Program.
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