Earn-A-Bike@HartfordLibrary | 1 p.m. Saturdays April 11 to May 16
Please read and fill out our BWorks registration carefully, and be sure to put the six class sessions, all taking place at the Hartford Public Library (143 W Hawthorne St, Hartford, IL 62048), on your calendar! Questions? Email evie@bworks.org
Please read before beginning this form...
Earn-A-Bike is a free, hands-on class that teaches basic bicycle maintenance and safety along with life skills including communication, teamwork and responsibility to children and teens ages 8 to 17 who already know how to ride a bike. After completing six two-hour classes, participants earn a bicycle of their choosing, plus a brand-new helmet, light set and lock they take home on the last day. Students who commit to this series under the guidance of dedicated BWorks instructors will meet at Hartford Public Library (143 W Hawthorne St, Hartford, IL 62048) from 1 p.m. to 3 p.m. on Saturdays from April 11 to May 16. Up to two students from within a single household can be registered (please fill out this form once for each child, if registering two) within the cohort, which is capped at 12 total students.
Parent/Guardian Name
*
First Name
Last Name
Parent/Guardian Email
*
example@example.com
Parent/Guardian Cellphone
*
Format: (000) 000-0000.
Student Name
*
First Name
Last Name
Student Gender
*
e.g., male / female / nonbinary
Is English the primary language spoken in your home? If not, what is your child(ren)'s first language?
*
Does your child have any allergies or medical conditions our staff and volunteers should be aware of? (please specify)
*
e.g., peanut allergy
Student Height
*
If you're not exactly sure, an estimate is great!
Student Age (as of the first day of this class series)
*
St. Louis BWorks serves students ages 8 and up.
Where does your student attend school?
*
e.g. Hartford Elementary, Lewis & Clark Junior High, etc
How did you first hear about BWorks?
*
Word of mouth (e.g. from a friend, school connection, neighbor)
Social media (e.g. via Facebook, LinkedIn, Bluesky)
Online search for such services
Other
Student Ethnicity
*
This six-week class is taking place at Hartford Public Library on Saturdays beginning April 11. It runs each week through May 16.
*
I understand the time, place and dates of this BWorks course, and I am placing the dates, times and location on our calendar now so that we stay committed to our student consistently attending the six sessions of the class.
Earn-A-Bike classes are specifically geared for children ages 8 to 17, and students must already be able to ride independently on two wheels in order to participate. (NOTE: BWorks offers a separate course, Learn-To-Ride, year-round for children and teens ages 8 and up who still need to learn to ride a bike.)
*
I understand and confirm that my student is able to ride a bike independently (without training wheels or other assistance). I also understand that if a student begins the course without knowing how to ride a bike, my student may not be able to complete the course or take home a bike, since this class is designed for youth who already know how to ride a bike.
The BWorks team and our school partners around the region, including Hartford Public Library, put a great deal of time, effort, imagination and labor into each Earn-A-Bike series. It's important that student participants and their caregivers honor that with consistent, engaged attendance.
*
I understand how important this commitment is, as does the student I am registering. We understand there are limited spots, and we commit to making this class a priority to help make this series a success for everyone involved.
Household Primary Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
St. Louis BWorks Program Permission, Liability, Medical and Photo Release Form
I understand and have read the above BWorks Program Permission, Liability, Medical and Photo Release Form.
Submit
Should be Empty: