Earn-a-Bike Registration Form
Please complete this form to register for the first Earn-a-Bike of 2018!
The program runs Tuesdays, February 20 - March 27 5:30-7:30 at Open Roads (1523 Riverview Dr. Suite B in Kalamazoo)

*Note: Earn-a-Bike programs are open to all students ages 10-15 years of age. Earning a bicycle at Open Roads is about gaining independence and self-sufficiency, learning how to be active and healthy, having a community to learn and grow with, and feeling safe and supported!

*Full scholarships are available for students who need one. Payment is NEVER a barrier for students who want to participate. Please learn more about this in our "Need" section at the bottom of this form.

*Please submit one registration form per student.
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The Basics
Please provide the following information so we can notify you as soon as a program for your student becomes available for the 2018 program season.
Adult Contact Name (first and last) *
Adult Contact PHONE NUMBER *
Adult Contact EMAIL (please check this email regularly as this will be a primary form of communication) *
Name of Student for Earn-a-Bike program *
Age of Student for Earn-a-Bike program *
Required
Student Gender Identification *
Student Approximate Height (feet, inches) *
Need
At Open Roads we aim to serve students who can most benefit from our small group skill-development setting. We have generous donors who have made full scholarships 100% possible for ANY student who requires financial support. The suggested fee for this six week program is $125. With this knowledge, please indicate the financial support the student(s) you are registering may require:
Financial Support *
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