Peloton Enrollment Form

* Indicates required field

Participant Name *

First

Last

Participant Date of Birth *

Parent Email *

Parent Name *

First

Last

Comments *

Choose 1 Class Per Week per Peloton Session *

Monday 5-6p, Peloton Second Quarter Session,April 2 - June 16, 2018, $110 Monday 6-7p, Peloton Second Quarter Session, April 2 - June 16, 2018, $110 Friday 5-6p Peloton Second Quarter Session, April 2 - June 16, 2018, $110

Is this your FIRST time enrolling in the Peloton *

Yes No

Is your athlete interested in racing? *

Yes No Not Sure

Submit

Peloton Enrollment Form

Changing lives through cycling.

Address:

Telephone

Email