Registration Form - Private Basic Rider Course  (* = required fields)



Tell Us About Yourself

  Middle Initial:    Last Name*:

Address Line 1*: 

Address Line 2: 

City*:    State*:    Zip Code*:

Day Phone*:    Evening Phone:

eMail Address*:   

Age*:

Schedule

Please call our office to set up a customized schedule. 781-974-2474

Notes (where did you hear about Streetwise Cycle School?):

If you are redeeming a Gift Certificate for full or partial payment, enter the Certificate Number below:

Gift Certificate Number:

Signature

  Check here if you have a leg in-seam less than 26 inches.

  Check here if you have a hearing, reading, or other type of DISABILITY.

  Check here if you have a primary language other than English.

If you checked any of the above items, please call the office at (781) 974-2474 prior to registering to discuss if we can accommodate your special needs.

Read the Terms, Course Descriptions, and Course Requirements and click on the "Yes, I ACCEPT" box below.

I ACCEPT the Terms, Course Descriptions, and Course Requirements outlined above?*

You must accept the Terms, Course Descriptions, and Course Requirements in order to register.