Valley Preferred Cycling Center Summer Bike Camps Registration Form
Welcome to our summer bike camps! Please fill out the form to register your child for an exciting cycling experience.
Participant Information
Participant's Full Name
*
First Name
Last Name
Age Range
*
Please Select
4-7
7-12
13-15
16-18
19+
Month of Camp
*
Please Select
June
July
August
Camp Level
*
Please Select
Weeble Wobbles
Pee Wee Pedalers
Level 1
Level 2
Parent/Guardian Information
Parent/Guardian Full Name
*
First Name
Last Name
Parent/Guardian Email Address
*
example@example.com
Parent/Guardian Phone Number
*
Please enter a valid phone number.
Emergency Contact Information
Emergency Contact Full Name
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Emergency Contact Relationship to Participant
*
Submit
Should be Empty: