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* 1. First and Last Name:

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* 2. Phone Number:

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* 3. Email Address:

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* 4. Part of the Traffic Skills 101 Course includes riding your bicycle. Will you be able to bring your bicycle?

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* 5. Traffic Skills 101 requires participants to wear a helmet while riding. Will you be able to provide your own helmet?

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* 6. Do you have any special accommodations (ex. food allergy, breastfeeding space, etc.)?

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* 7. Any other questions/comments?

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