City Hall455 N. MainWichita, Kansas 67202 Emergency Assistance: Dial 9-1-1 Police Department
City Hall455 N. MainWichita, Kansas 67202
Emergency Assistance: Dial 9-1-1
Police Department
City of Wichita > City Offices > Police Department > Police Forms > Application for Bicycle Clinic
Please fill in all areas of the form below: Child's Name Street Address City State Zip/Postal Code Home Phone Work Phone Parent/Guardian Name Age of Participant Email Address List Family Doctor below: List Hospital Preference below: List any handicaps or physical ailments below: I will provide a helmet for my child: Yes No Please list your date preference below: Please pick your 1st choice date Please pick your 2nd choice date Please pick your 3rd choice date 2008 Bicycle Clinic Schedule Ages 6-8 Dates & Locations Ages 9-11 Dates & Locations Ages 6-8 Dates & Locations Ages 9-11 Dates & Locations June 5June 9June 16June 18June 23June 25June 30 (A)(C)(D)(F)(G)(H)(I) June 6June 10June 17June 19June 24 (B)(C)(E)(F)(G) July 7July 10July 22 (J)(L)(M) July 1July 8July 9July 11July 23 (I)(J)(K)(L)(M) CODE AREA BUILDING ADDRESS (A) North Jackson Elementary School 2717 N. Woodlawn (B) Central Pleasant Valley Elementary School 2000 W. 29th St. North (C) West Northwest High School 1220 N. Tyler Rd. (D) South Anderson Elementary School 2945 Victoria (E) South Enterprise Elementary School 3605 S. Gold (F) South Linwood Elementary School 1654 S. Hydraulic (G) East Central Christian Church 2900 N. Rock Rd. (H) East Seltzer Elementary School 11660 E. Lincoln (I) East Curtis Middle School 1031 S. Edgemoor (J) North Stucky Middle School 4545 N. Broadview Circle (K) South White Elementary School 5148 S. Kansas (L) West McCollom Elementary School 1201 Waddington (M) West West High School 820 S. Osage You will be notified of your assigned date of attendance, via mail within 7 days! Please Read Carefully The undersigned parent and/or guardian of the above named applicant, and for such applicant and for myself, my heirs and assigns, hereby releases, discharges and forever holds harmless the City of Wichita, it servants and agents, and the Wichita Police Department and all members thereof from any and all damages or claims for personal injury or otherwise which may arise by reason of the above applicant's receiving bicycle training from the Wichita Police Department. The Signature part of this form will be signed by the parent/guardianat check-in time, on location. Please be patient after hitting the submit button, process can take up to 15 seconds.
Please fill in all areas of the form below:
Child's Name
Street Address
City
State
Zip/Postal Code
Home Phone
Work Phone
Parent/Guardian Name
Age of Participant
Email Address
List Family Doctor below:
List Hospital Preference below:
List any handicaps or physical ailments below:
I will provide a helmet for my child:
Yes No
Please list your date preference below:
2008 Bicycle Clinic Schedule
Ages 6-8
Dates & Locations
Ages 9-11
June 5June 9June 16June 18June 23June 25June 30
June 6June 10June 17June 19June 24
You will be notified of your assigned date of attendance, via mail within 7 days!
Please Read Carefully
The undersigned parent and/or guardian of the above named applicant, and for such applicant and for myself, my heirs and assigns, hereby releases, discharges and forever holds harmless the City of Wichita, it servants and agents, and the Wichita Police Department and all members thereof from any and all damages or claims for personal injury or otherwise which may arise by reason of the above applicant's receiving bicycle training from the Wichita Police Department.
The Signature part of this form will be signed by the parent/guardianat check-in time, on location.
Please be patient after hitting the submit button, process can take up to 15 seconds.