Kids Repair Program

Hi All. Bike camp is official full for the month of June. We still have seats available for the months of July and August, but they too are filling up fast. Bike camp is free this year, but we do request a $25 deposit (refundable when your child completes camp). Copy and past the information below into an email and send it to us as [email protected] to reserve a seat.
Kids Repair Program
5815 Wise Rd.
Lansing, MI 48911
(517) 755-4174 or (517) 894-7001
[email protected]

2026 Bike Camp Student Registration Form (ages 10 to 17)
Parent/Guardian Permission
(Please print clearly)

Session Week Requested__
(registration is not complete until confirmed by staff and deposit is paid)

My child has years of experience riding a bike.

Child’s Name:

Nickname (if any): ____________________

Address:_

City:_ State: Zip:

Phone:

Date of Birth: Male:______Female:

School: Okemos School Grade:

County: Ingham email:

Child can be released to or in case of emergency, if I cannot be reached, please contact:

1. Name: Phone:

2. Name:______________________________ Phone: ______________________

My child has been diagnosed by a doctor to have:(Please check all that apply)

___Attention Deficit Disorder ____Dyslexia ____Vision Problems
___Hearing Problems ____Other (please explain) ______________________________

Special attention and/or medication: ___________________________________________________

KRP has permission to use my child’s photo in video and publications, for the purpose of advertising and promoting KRP. ****Yes ______ No______

Statement of Permission:

I would like my child to participate in the Kids Repair Program. I will not hold any person or agency connected with KRP responsible for loss or harm, including injury to my child during his/her participation in the program. I understand that KRP’s liability insurance coverage is exclusive to students only while in attendance Kids Repair Program Classes, during the times allocated on each student’s schedule and ending at graduation.

Parent/Guardian Signature: _______________________________________

Date: _______________

KRP Representative Signature: ____________________________________

Date: _______________

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