Booking Form (For newcomers only)
Name of student:............................................................................
Address:....................................................................................... ................................................................................................... ...................................................................................................Tel. No.:...................... Age:............. Approx. height..................
Please indicate if the student:
If you have answered 'yes' to questions 2, 3 or 4 above, please provide additional details: .................................................................................................... .................................................................................................... Course dates from:....................(mm/yy) to:......................(mm/yy) Please note, each course consists of four, one hour lessons, held consecutively but not necessarily within the same calendar month.
Yes No 1. Is able to balance on two wheels unaided ¨ ¨ 2. Suffers from hearing difficulties ¨ ¨ 3. Suffers from asthma ¨ ¨ 4. Suffers from any form of disability that may affect their ability to ride a motor-cycle ¨ ¨ Please indicate your preferred day / time:
Saturday Sunday ¨ 10:00 to 11:00 ¨ 14:00 to 15:00 ¨ 11:00 to 12:00 ¨ 15:00 to 16:00 I enclose herewith a cheque for £........... as payment for the course of four lessons and I understand that it is my responsibility to ensure the student is available and on time to be taught. Please make all cheques payable to S. Newell and write the cheque guarantee number on the back.
I have read the CYR website / accompanying letter providing full information about CYR.
Signed:............................................................... (Signature of parent/guardian is required if student is less then 18yrs old)Date:........................
eMail:info@chilternyoungriders.co.uk www.chilternyoungriders.co.uk Telephone: (01494) 728618
