Bike Program Registration form
Our Strider bike program offers an opportunity to promote bike riding readiness with the use of pedal-less bikes called balance bikes. Students learn to recruit core muscles and practice bi-manual strength and coordination for bike riding skills. Appropriate for ages 3- 18.

For more information about the program, please visit: http://unbridledrehab.com/services/bike-program/

Tell us about your child!
One form per child, please!
What is your child's name? *
Your answer
Is your child currently a client with URS? *
What is your child's age? *
Your answer
Does your child have any special needs we should know about? *
(please include diagnosis if you have one!)
Your answer
Tell us about yourself!
(Parent or guardian)
What is your name? *
Your answer
What is the best email for us to reach you? *
(We dislike spam as much as you do and will never give away or sell your email address, promise)
Your answer
What is the best phone number for us to reach you? *
Your answer
We need a parent or guardian to attend with each child. To agree, please type your full name in the box below. *
To make for the best possible experience, I understand that a parent or guardian needs to attend with each child:
Your answer
We provide the bikes, you provide the safety! Please bring a well fitted bicycle helmet or equivalent for each child that attends. To agree, please type your full name in the box below. *
To make for the best possible experience, I understand that a parent or guardian needs to attend with each child:
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of Kaely Linker. Report Abuse - Terms of Service - Additional Terms