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Books to Bikes Community Program
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Forms for Parents
Please complete all forms below

Contact information

Child First name*

Child Last name

Parent First Name*

Parent Last Name

Phone

Emergency Contact information

Photography consent & release form

Child First name

Child Last name

I hereby give my consent to use my photographs according to the Terms & Conditions.

Confirm with Parent Initials*

Health declaration

Parents please fill out the following form.

First name

Last name

Date of birth

Month

Day

Year

Has your child suffered from a medical condition, illness or injury in the past year?

No

Yes

Did your child have any concerns with speech and language development? (i.e. Delayed speech)

Initials*

I declare that the info I’ve provided is accurate and complete.

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