Bike Camp 2020
Little Steps Pediatric Therapy
41 Waukegan rd. Glenview
847-707-6744
info@littlestepspt.com
Email address *
Childs Name *
Date of Birth *
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DD
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Guardian Name *
Best Contact Number *
Home Address *
Email *
Current or Past Patient? *
Required
What session will you be attending? (If you would like to sign up for more than one session, please select one time from session 1 and one from session 2) *
Required
I acknowledge that I will need to bring my own bike and helmet to each day of camp. *
Required
I would like to see if my insurance can be used for Bike Camp *
I understand that if I am not using insurance, the full amount of Bike Camp is due by the 1st day of camp. *
Required
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