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Project Ride Student Enrollment Form
Date of Submission:
Month
-
Day
-
Year
00
01
02
03
04
05
06
07
08
09
10
11
12
Hour
:
00
05
10
15
20
25
30
35
40
45
50
55
Minutes
AM
PM
Student's First Name:
Student's Last Name:
Date of Birth:
dd-mm-yyyy
Gender:
Male
Female
Attending School:
Cedarbridge
Berkeley
Saltus
Warwick Academy
MSA
BHS
Somersfield Academy
Bermuda Institute
Homeschool
Other
Student's Contact Number:
Phone Number
Student's Email:
Parent/Guardian's First Name:
Parent/Guardian's Last Name:
Address:
Parish:
City of Hamilton
St. George's
Hamilton
Smiths
Devonshire
Pembroke
Paget
Warwick
Southampton
Sandys
Postal Code:
Parent/Guardian's Contact Number:
Phone Number
Parent/Guardian's Email:
Project Ride Instructor:
Christopher Swan
Dawnette Lewis
Sarah Robinson
John Barnes
Shelly Grace
Rachael Robinson
Please only submit this form once. Thank you!