Cycle Trainer CourseSign-up Form Personal Information Name * First Name Last Name Email * Phone * (###) ### #### Post Code * Date of Birth * MM DD YYYY Ethnic Background (if applied) Primary Language * Other Languages Spoken * Cycling Habits How often you go cycling (e.g. once a week, twice a month) * Mode of Journey * Commuting to Work/School Leisure Fitness Others How confident if you ride on roads with traffic? * Very confident Confident Moderately confident Not confident Do you know simple bike repairs i.e. mend a puncture or replace a damaged inner tube. * Yes No Do you own a bike? * Yes No Skills and Experience Do you have any previous experience with cycling initiatives or volunteering? (Please describe briefly) * Additional Information Do you have any medical conditions or allergies we should be aware of? * Any other information you would like to share? How do you hear from us? Enrollment Code (if applicable) Thank you! Our volunteer coordinator will contact you for a cycle assessment shortly.
