Bike School Application

Applications for Summer 2024 programs are now open. Please select the Bike School program(s) you are applying to.

Please consider me for:

A note about program fees:

I understand that, upon acceptance to the program, an amount between $50 and $100 is to be provided to Bikes Not Bombs no later than one week before the start of the program. Without payment, the spot will be released to the next participant on the waitlist.

If program fees are a concern, please provide a statement requesting a fee waiver, explaining the circumstances that make it necessary to do so. Without this statement, the spot will be released to the waitlist.

1. Applicant Personal Information

First Name:

Last Name:

Middle Name:

Address (street):

City:

State:

ZIP Code:

Home Phone #:

Cell Phone #:

Other Phone #:

Neighborhood you live in:

Email:

Birthdate:

Will you be over 18 by the program start date?

YesNo

Gender:

Pronouns

Race/Ethnicity:

Languages Spoken:

Do you identify as a member of the LGBTQ+ community? (Optional)

Do you identify as neurodivergent and/or have a disability? (Optional)

Emergency Contact #1 (Must be parent/legal guardian if under 18)

Emergency Contact Name:

Relationship to you:

Address

Home Phone #:

Cell Phone #:

Email:

Emergency Contact #2

Emergency Contact Name:

Relationship to you:

Address

Home Phone #:

Cell Phone #:

Email:

2. Education Information

Name of School/GED Program:

Grade

3. Medical Information

Illnesses: (If none, type "N/A")

Allergies: (If none, type "N/A")

Injuries: (If none, type "N/A")

Medications: (If none, type "N/A")

Physical Limitations: (If none, type "N/A")

Name of Health Care Provider:

Health Card/Policy #:

Clinic/Hospital:

Clinic/Hospital Phone #:

Physician's Name:

Physician's Phone #:

4. Questionnaire

How did you hear about this program?

Did someone refer you to Bike School? If so, who?

Why do you want to enroll in this program?

How would you describe your communication skills?

What would you like to do with your refurbished bicycle?

What is your height?

(If donating your bicycle) What is the height of the person you intend to give your bicycle to?

Are you interested in working as a Youth Apprentice after graduating Bike School?

YesNoMaybe/Not Sure

We can provide 5-8 speed bicycles for students. You don't need to answer every question, but the more information you can give us, the better we're able to assess your needs and align them to what bike is selected for you.
How often would you like to ride your bike? Where would you like to ride your bike? For commutes or leisure? Do you want flat or drop handlebars? Would you prioritise speed or comfort? Do you have any other needs for your bicycle that you'd like us to consider? We will do our best to accommodate them.

5. Pick Up Plan

Participants 15 and under should have a transportation plan in place to and from the program, and notify the program supervisor before their departure each session.

Departure Method:

Additional pick up and transportation information:

Contact Information