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Bikes for Neighbors Intake Form
Bikes for Neighbors is a program of the Shenandoah Valley Bicycle Coalition that focuses on increasing personal freedom and mobility through bicycles. Interested participants should fill out the form below
.
The program aims to provide each participant with a professionally refurbished bicycle complete with rear rack, front and rear lights, floor pump, helmet, and lock.
A $100 contribution is expected for each bicycle distributed, which will improve the program's impact and create a sustainable model.
The program aims to help income-constrained individuals who could use a bicycle for transportation or in their daily lives.
More information on
Bikes for Neighbors
What We Need From You
For us to contact you, we need a
waiver on file.
The first step of this process is to complete our online waiver below.
As a participant, I have signed the required Risk and Release Waiver.
*
Click to
Sign Risk and Release Waiver
, or I have passed this on to the participant to sign
As a participant, I have signed the required Risk and Release Waiver.
Yes, I have signed the required waiver
Who is the referring organization? (example Community Service Board, Navigation Center, Church World Services, Strength in Peers, and plenty more )
*
We work off a referral system, whereby we serve people who are referred by an organization. If you don't have a referral, let us know, and we'll see what we can do. The first step will be to see if you are connected with any organizations that could refer you.
Name of referring case worker
*
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