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First name * *

Last name * *

Email * *

Phone * *

Residence Zip Code * *

Number of Participants *

Rider First Name *

Rider Last Name

Rider Age *

Bike Wheel Size

Would you like to rent a mountain bike? ($75.00)

Please Enter Participants Height

Purchase mountain bike gloves! (Included for After School Program)

Purchase an Event T-shirt! (Included for After School Program)

Rider First Name

Rider Last Name

Rider Age

Bike Wheel Size

Would you like to rent a mountain bike? ($75.00)

Please Enter Participants Height

Purchase mountain bike gloves! (Included for After School Program)

Purchase an Event T-shirt! (Included for After School Program)

Rider First Name

Rider Last Name

Rider Age

Bike Wheel Size

Would you like to rent a mountain bike? ($75.00)

Please Enter Participants Height

Purchase mountain bike gloves! (Included for After School Program)

Purchase an Event T-shirt! (Included for After School Program)

Rider First Name

Rider Last Name

Rider Age

Bike Wheel Size

Would you like to rent a mountain bike? ($75.00)

Please Enter Participants Height

Purchase mountain bike gloves! (Included for After School Program)

Purchase an Event T-shirt! (Included for After School Program)

Rider First Name

Rider Last Name

Rider Age

Bike Wheel Size

Would you like to rent a mountain bike? ($75.00)

Please Enter Participants Height

Purchase mountain bike gloves! (Included for After School Program)

Purchase an Event T-shirt! (Included for After School Program)

Please list any medical conditions or allergies. *

Emergency Contact First and Last Name *

Emergency Contact Phone Number *

I have read, agree to and understand the Sprockids San Diego photo release waiver. Photo Release Waiver *

I have read, agree to and understand the Sprockids San Diego liability waiver. Liability Waiver *

I agree with Rental Terms & Conditions*

Product	Subtotal
Escondido ~ After School Program × 1	$429.00
Subtotal	$429.00
Service Fee	$9.95
Total	$438.95

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