FORM RegoSCC v2

1. How often do you currently...*

Rows	None	1x week	2x week	3x week	4x week	>4x week
Ride your bike?
Engage in non-cycling exercise?

2. How do you rate your current level of confidence about...*

3. How do you rate your current level of fitness?*

Rows	Below Average	Average	Good	Very Good	Excellent
Fitness

4. What type of bike do you have?*

Road Bike (Skinny tyres, curly handlebars)Hybrid (Flat bar, medium tyres)Mountain Bike (Knobbly tyres)Cruiser BikeBMXOther
5. Do you have cycling shoes with cletes & 'clip-in' pedals?*

NoYes
6. Can you ride with one hand (for drinking, signalling etc)*

NoSort ofYes
7. What is the longest ride you have done?*
8. What are your expectations of this program/session?*
9. Any health issues?*
10. How did you hear about Sara Carrigan Cycling?*
11. Other notes
Other Participants

Attending Private Group Session
PLEASE NOTE: It is a requirement for each participant to complete the registration form PRIOR to the session. Attendance is not permitted without a completed registration form.

Please list the other participants below and they will be contacted to complete the registration form.
-- PARTICIPANT 2
Participant 2: Name*

First NameLast Name
Participant 2: Email*
-- PARTICIPANT 3
Participant 3: Name*

First NameLast Name
Participant 3: Email*
-- PARTICIPANT 4
Participant 4: Name*

First NameLast Name
Participant 4: Email*

Terms and Conditions*

I have read, understand and agree to the Terms and Conditions for participation in the Cycling Program (www.saracarrigan.com/TCs)
Bike & Safety *

I understand that it is my responsibility to bring my bike well maintained, with all safety gear – including Australian Standards helmet & brakes in good working order.If I am in doubt as to the maintenance status of my bike, I will have it assessed, and if necessary repaired, by an experienced bike mechanic / bike shop BEFORE the ride. (www.saracarrigan.com/BikeSafetyChecklist)
Participant Name*

First NameLast Name
Name of parent/legal guardian (if participant under 18)
I am authorised to accept Terms & Conditions as parent/legal guardian of the Participant
Registration Date*

DayMonthYear

My Products

Cycling Skill Session$ FreeAUD

Type of SessionQuantity

Travel Fee$80.00AUD

Please select if your session will be held outside the standard service area.

Enter coupon

Subtotal $0.00AUDTax $0.00AUDTotal $0.00AUD

REGISTRATION FORM