1:3 Sessions for Non Riders - Wicor Primary School, Fareham - Fri 25th, Mon 28th July, Thurs 28th or Fri 29th Aug 2025

Full name of child attending

DOB of child attending

Gender of child Male Female Prefer not to say Prefer to self-describe as

If gender answer above is self-describe please state here

Current year group at school

Current School Attending

Details of any medical needs or additional support to learning

Medical information - medication will need to be given to instructors on the day

First emergency contact name, number and relationship

Second emergency contact name, number and relationship

My child needs to borrow a bike Yes No

My child needs to borrow a helmet Yes No

Read the product details below? If No is selected you will be contacted by a learning coordinator to ensure that you are prepared for the training No Yes

Will your child be collected or make their own way home? Collected Make their own way home