Kids & Teens Registration Form

If you have trouble with the form, please try using a Google browser.

Once you have completed the registration form, you will see a link to the waiver, and you will receive a confirmation email from us. Please check your junk folder or contact us if you didn't receive it.

Participant's Name*

Parent/Guardian Name*

Parent/Guardian Email*

Name of Emergency Contact*

Emergency Contact Phone #*

Birthday of Participant*

Year

Month

Day

Select Your Program (And 2nd Program if Applicable)*

Fall Beginner Monday 4pm

Fall Intermediate/Advanced Saturday 9:30am

Fall Intermediate/Advanced Wednesday 4pm

Cyclocross

Race Team

Private/Custom

QMS Fall Advanced Beginner Monday 4pm

QMS Fall Advanced Beginner Wednesday 4pm

QMS Fall Intermediate/Advanced Monday 4pm

QMS Fall Intermediate/Advanced Wednesday 4pm

**For new registrants**: Bike make, model, year, and wheel size

What are your goals for this program?

Please list any allergies

Is there anything else we should know about your child?

From time to time we take photos of our participants in action. Do you consent to your child's photo being used in our materials?

Yes

How did you hear about us?

I have read and agree to the Dirt Groms Terms & Conditions.

I understand that I must complete the required Dirt Groms waiver through WaiverFile before participating.

Subscribe me to your newsletter for ride updates and program schedules.

BOOK YOUR RIDE

Lessons, small groups, guided rides and race teams. Tell us your goals and we'll match you with the right coach.

CONTACT

Amanda McArthur

dirtgroms@gmail.com

250-710-7044

RIDE WITH US

Guided Rides (coming soon)

bottom of page