Peloton Enrollment Form - CCF Classes

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Peloton Enrollment Form

* Indicates required field

Participant Name *

First

Last

Participant Date of Birth *

Parent Email *

Parent Name *

First

Last

Ethnicity *

Asian African American Caucasian Latino Other

Does your athlete have a medical condition we should know about? *

Yes No

Choose Session *

Monday 5-6p, Peloton Second Quarter Session, April 1 - June 28, 2019, $165 Monday 6-7p, Peloton Second Quarter Session, April 1 - June 28, 2019, $165 Friday 5-6p Peloton Second Quarter Session, April 1 - June 28, 2019, $165

Is this your FIRST time enrolling in the Peloton *

Yes No

Is your athlete interested in racing? *

Yes No Not Sure

Does your athlete wish to ride more than one 1-hour class each week (and is able to commit to riding additional time) *

Yes No

parent sign up for class volunteer *

Yes No Maybe at a later date

Comments *

Submit

Changing lives through cycling.

Address:

P.O. Box 681
Corona Del Mar, CA
92625

Telephone

800-431-5281

Email

info@conniecycling.com

Connie Cycling Foundation is a 501(c)3 nonprofit organization, Tax ID#45-4372870