Little Wheel Werks - Myfave Aug

1

2

To reserve only your FIRST class, please submit the booking request form.

(Subsequent classes will be based on the same day & time as your first class)

3

Your name please?* This field is required.Who bought the voucher?

First Name

Last Name

4

E-mail* This field is required.

example@example.com

5

Phone number* This field is required.

6

Learner's name(s)Who is learning?

First Student

Second Student

7

Learner's age(s)* This field is required.As of current year

e.g. 5 & 8 (Please indicate a comma if more than one student)

8

Voucher Code* This field is required.Please key in your purchased voucher code(s)

Please indicate a comma if more than one(1) voucher

9

Voucher Type* This field is required.Please select the voucher you have purchased

1-Hour Inline Skating Class for 1 Adult / Child (2 Sessions)

1-Hour Inline Skating Class for 2 Adult / Child (2 Sessions)

30-Minute Bike Balancing Class for 1 Child (1 Session)

10

Location (Inline)* This field is required.Please select the teaching centre

East Coast Park (Saturday)

West Coast Park (Sunday)

11

Location (Bike)* This field is required.Please select the teaching centre

East Coast Park (Saturday)

West Coast Park (Sunday)

12

East Coast Park (Inline-Skating)* This field is required.Inline-Skating

13

East Coast Park (Bike)* This field is required.Bike-Balancing

14

West Coast Park (Inline)* This field is required.Inline-Skating

15

West Coast Park (Bike)* This field is required.Bike-Balancing

16

Is there anything we need to know prior class? (Optional)Please indicate if student requires special assistance

e.g. Past Injury, Medical History, Special Needs, Skin Condition, Allergies

17

Do you have your own training essentials??* This field is required.For Hygiene purposes & due to Covid-19 measures, we advise learners to have a personal set (Wrist, Knee, Elbow, Helmet) - Select what you have

Helmet

Wrist, Elbow & Knee Pads

Rollerblades

Balancebike

Purchase NEW ($32) - wrist, elbow & knee pads

18

Terms & Conditions* This field is required.note: Dates requested are not confirmed until a CONFIRMATION message is sent to you via SMS/WhatsApp/Email. Our team will get in touch with you soon! | "LIke" us @ www.facebook.com/littlewheelwerks | TERMS & CONDITION I acknowledge and agree that participating in physical activities comes with inherent risks, therefore students must be responsible for their own safety during urban. | All safety equipment should be worn always during the event. | I undertake to ensure strict compliance with all rules, regulations and instructions given during the Event to minimize risk factors. | Whilst reasonable precaution will be taken by Little Wheel Werks to ensure student’s safety. | I understand that as a participant I take part at my own risk. Little Wheel Werks and their instructors will not be held liable for any injury arising from participating in this event. | I understand that pictures and videos will be taken during event and may be used in social media platform as well as marketing materials. | Little Wheel Werks reserves the rights to reject students who are deemed unfit for class (if undeclared upon registration).

I AGREE to the above Terms & Conditions

19

Health Declaration* This field is required.1. Have you traveled abroad (i.e. to any countries outside of Singapore, excluding Brunei and New Zealand) in the past 21 days? 2. Do you have flu-like symptoms (e.g. fever, cough, runny nose, sore throat or loss of taste/smell, etc.)? 3. Are you currently: (i) serving Stay-Home Notice (SHN); OR (ii) serving Quarantine Order (QO) issued by the Ministry of Health (MOH)? (iii) a Person Under Phone Surveillance (PUPS) by MOH? 4. Have you, in the past 14 days, had close contact with a COVID-19 person?

"No" to all questions above

"Yes to one(1) or more to questions above

20

The information you provide is important in managing the risk of COVID-19 transmission. The Infectious Diseases Act requires a person who has reason to suspect that he is a case or carrier of COVID-19, or has had contact with a person with COVID-19, to act in a responsible manner to not expose other persons to the risk of infection by the disease.