Bike To School Registration - 2011

1. Thank you for registering for Bike to School Week 2011!

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* 1. Parent/Guardian First Name

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* 2. Parent/Guardian Last Name

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* 3. Please provide contact information. This will be used to notify you if your child is a prize winner and/or to complete a follow-up survey.

e-mail

phone

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* 4. Age:

First Child:

Second Child:

Third Child:

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* 5. Grade:

First Child:

Second Child:

Third Child:

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* 6. School:

	Elementary	Middle	High	Charter
First Child	First Child Elementary menu	First Child Middle menu	First Child High menu	First Child Charter menu
Second Child	Second Child Elementary menu	Second Child Middle menu	Second Child High menu	Second Child Charter menu
Third Child	Third Child Elementary menu	Third Child Middle menu	Third Child High menu	Third Child Charter menu

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* 7. Estimated biking distance (per day):

First Child:

Second Child:

Third Child:

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* 8. What days are you planning on riding as part of Bike to School Week (May 14-20)?

	Sat	Sun	Mon	Tues	Wed	Thurs	Fri
First Child	First Child Sat	First Child Sun	First Child Mon	First Child Tues	First Child Wed	First Child Thurs	First Child Fri
Second Child	Second Child Sat	Second Child Sun	Second Child Mon	Second Child Tues	Second Child Wed	Second Child Thurs	Second Child Fri
Third Child	Third Child Sat	Third Child Sun	Third Child Mon	Third Child Tues	Third Child Wed	Third Child Thurs	Third Child Fri

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* 9. Are you planning to participate with your child or their school during Bike to School Week?

No, my child is riding on their own or with another adult

Yes, I plan on riding with my child

Yes, I plan on riding with additional students

Other (please specify)

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* 10. I understand that for my child to bike to school, I agree to:

	Yes
Check every bike to ensure it is ready to ride	Check every bike to ensure it is ready to ride Yes
Make sure that everyone riding wears a helmet	Make sure that everyone riding wears a helmet Yes
Make sure we ride with friends or family	Make sure we ride with friends or family Yes

For the safety of your children, all children should be at least 10 years old to ride to and from school, and we encourage all students to ride with a parent or adult. Bike to School Week is a community event and not a Washoe County School District sponsored event. Specific schools are choosing to participate. TMBA reserves the right to remove any groups or individuals due to misuse or misrepresentation.