Language
English (US)
Spanish (Latin America)
Portuguese (Brazil)
Spring session starts February 23rd
Earn-A-Bike Registration
Participant Information
Child's Name
*
First Name
Last Name
Birth Date
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Please select a year
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
Year
Age
*
School
*
Grade
*
Gender
*
Please Select
Female
Male
Transgender
Non-Binary
Prefer not to answer
Ethnicity
*
Please Select
Hispanic/Latino
Not Hispanic/Latino
Prefer not to answer
Race
*
Please Select
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
Multi-racial
White
Prefer not to answer
Free/Reduced Meals
*
Please Select
Yes
No
Prefer not to answer
Parent/Guardian Information
Parent/Guardian Name
*
First Name
Last Name
Cell Number
*
-
Area Code
Phone Number
Home Number
-
Area Code
Phone Number
E-mail
*
Relationship to Child
*
Emergency Contact Information
Emergency Contact Name
*
First Name
Last Name
Cell Number
*
-
Area Code
Phone Number
Relationship to Child
*
Signature
*
SUBMIT
SUBMIT
Should be Empty: