Volunteer Registration Form
Host name:
Camp dates:
Camp location/address:

We are pleased to offer this bike program to people with disabilities and look forward to having you play an important part in helping our riders learn to ride a two-wheel bicycle independently.

***NO PRIOR EXPERIENCE WORKING WITH PEOPLE WITH DISABILITIES IS NECESSARY***

AGE REQUIREMENT: Volunteers must be at least 15 years old.
If you are under 15, please contact the Camp Host for possible opportunities.

For questions please contact
Volunteer First Name
Your answer
Volunteer Last Name
Your answer
Gender
Date of Birth
MM
/
DD
/
YYYY
T-shirt size
E-mail address
Please ensure you have entered a valid email. The Camp Host will use this address when corresponding with you.
Your answer
Cell Phone
Please enter 10 digits
Your answer
Home Address (Number and Street)
Your answer
Home Address (City)
Your answer
Home Address (Zip Code)
5 digits only, please. e.g., 22011
Your answer
Home Address State/Province
Emergency Contact Name
Your answer
Emergency Contact Phone
Enter 10 digits only, please. e.g., 3031112222
Your answer
Parent/Guardian Email (if volunteer is under 18 y/o)
Your answer
Comments
Your answer
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