Free bike repair sign up
Please fill in this form to register your interest in the free bike repair hosted by Cyclox and Rose Hill Junior Youth club.
Full Name
*
E-mail
*
Phone Number
*
-
Area Code
Phone Number
Who is registering for the bike repair?
I am a parent or carer of a child who attends RHJYC sessions
I am a local parent or carer
I am a young person, aged 11+
I am a local resident referred by RHILC
Who is registering for the bike repair?
*
I am a parent or carer of a child who attends JYC sessions
I am a local parent or carer
I am a young person aged 11+
I am a local resident
Children's names (if they attend JYC after school sessions or JYC holiday clubs):
Briefly describe the problem with the bike (if known) or any relevant information for the mechanic
*
What slot I am able to attend (tick multiple if flexible):
*
3:00pm-3:30pm
3:30pm-4:00pm
4:00pm-4:30pm
4:30pm-5:00pm
5:00pm-5:30pm
5:30pm-6:00pm
6:00pm-6:30pm
6:30pm-7:00pm
SUBMIT
Should be Empty: