Kids Name *

First Name

Last Name

Date of Brith *

MM

DD

YYYY

Parental guardian *

First Name

Last Name

Phone *

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Do you need a Balance Bike? *

Bring My Own Balance Bike

need to rent a Balance Bike

*

I have completed the BMX Canada WAIVER and submitted it.