Volunteer Registration Form
Host name:  
Camp dates:  
Camp location/address:  

We are pleased to offer this bike program to people with disabilities and look forward to having you play an important part in helping our riders learn to ride a two-wheel bicycle independently.

***NO PRIOR EXPERIENCE WORKING WITH PEOPLE WITH DISABILITIES IS NECESSARY***

AGE REQUIREMENT:  Volunteers must be at least 15 years old.  
If you are under 15, please contact the Camp Host for possible opportunities.

For questions please contact

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Volunteer First Name
Volunteer Last Name
Gender
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Date of Birth
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T-shirt size
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E-mail address
Please ensure you have entered a valid email.  The Camp Host will use this address when corresponding with you.
Cell Phone
Please enter 10 digits
Home Address (Number and Street)
Home Address (City)
Home Address (Zip Code)
5 digits only, please.  e.g., 22011
 Home Address State/Province
Emergency Contact Name
Emergency Contact Phone
Enter 10 digits only, please.  e.g., 3031112222
Parent/Guardian Email (if volunteer is under 18 y/o)
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