iCanBike Registration Form

Summer Programs - iCan Bike
Registration may be completed by a child/youth or their parent/caregiver. Please review the criteria for iCan bike before completing and submitting your registration.
‘Participant’ refers to the child or youth applying to the program.
Please complete all required fields below (marked with *). If you have any questions or experience any issues, you may contact the ErinoakKids Intake team at 905-855-2690 (toll free 1-877-374-6625) and press 1 for support, from Monday-Friday, 8:00am to 5:00pm.
- Is the participant currently receiving ErinoakKids services?*
  
  YesNo
- Is the participant currently receiving services from another Children's Treatment Centre?*
  
  YesNo
- Not eligible
  
  The ErinoakKids iCan Bike program is for clients who currently receive services at a Children’s Treatment Centre. For community recreational options, please visit ErinoakKids – Community Resources. If you have questions, please contact ErinoakKids Intake at 905-855-2690 (toll free 1-877-374-6625) Monday to Friday 8:00a.m to 5:00 p.m.
- First Name:*
- Last Name:*
- Date of Birth*
  
  YearMonthDay
- Gender*
- Address*
  
  Street Address
  
  Unit Number (if applicable)
  
  CityProvince
  
  Postal
- First Name:*
- Last Name:*
- Relationship to Participant:*
  
  MotherFatherOther
- Please specify: *
- Phone Number:*
- Please Specify Type:*
- Extension (if applicable):*
- Email Address:*
  
  Confirmation Email
- Address Information:*
  
  Same as participantDifferent from participant
- Address:*
  
  Street Address
  
  Unit # (if applicable)
  
  CityProvince
  
  Postal Code
- Is the Primary Contact the legal guardian? If No, please complete the required fields*
  
  YesNo
- Agency Name*
- Caseworker Name*
- Caseworker Phone Number:*
- Extension (if applicable)
- Please enter the name of your current clinician. If you are receiving services from another Children’s Treatment Centre (CTC), enter your CTC clinician’s name. If you are receiving services at ErinoakKids, enter your ErinoakKids clinician’s name.
- First Name:*
- Last Name:*
- I understand that participants must be able to ride for the full 75-minute session and be able to attend all program sessions at John Tonelli Sports Centre (217 Laurier Ave, Milton), from July 20–24, 2026. I understand that a caregiver/parent is required to attend the orientation on July 19, 2026, from 4:00–5:00 p.m. I understand that, if accepted into the program, I will be given the opportunity to select my top three (3) time preferences for the 75-minute sessions. I acknowledge that enrolment is limited and registration does not guarantee a spot in the program. I will be notified of the registration outcome in May 2026.
- I understand:*
  
  YesNo
- Not eligible
  
  The participant does not meet the eligibility requirements for this program. Please speak with your clinician to discuss other resources that may be helpful.
- This request is being submitted with the knowledge and consent of named parents/legal guardians, in accordance with the ErinoakKids Privacy Policy available at erinoakkids.ca/privacy.
- Consent Received:*
  
  YesNo
- If No, ErinoakKids will not process this form.
- By providing the above contact information, you consent to receiving information about new service offerings, fundraising initiatives and free events offered at ErinoakKids by email, post, SMS/Text and other electronic means. ErinoakKids will always treat your personal details with the utmost care and will not share or sell your personal information. You may unsubscribe from receiving communications from ErinoakKids at any time. We are committed to keeping your information safe and confidential. We follow the reules set out in law about collecting, using and disclosing your personal information. For more information, please review our privacy policies publicly posted at erinoakkids.ca/privacy.
- Consent Received:*
  
  YesNo
- Please verify that you are human*
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Summer Programs - iCan Bike