Kohl's Kids Bike Smart Equipment Request Form for Summer 2017
Thanks for your interest in Kohl's Kids Bike Smart Equipment Loan Program (powered by Local Motion)! In order to help us prioritize and keep track of all requests, please take a moment to answer the questions below. E-mail Mary Catherine at marycatherine@localmotion.org if you need any help or clarification.

The Kohl's Kids Bike Smart Equipment Loan Program consists of: Bike Smart Bike Skills training curriculum, pre-training (if needed), a 20' trailer equipped with 30-40 kids' bikes (for ages 5-adult), tandem bicycles, optional assistive bicycles, balance bicycles, training materials and helmets--essentially everything that you would need to teach children bicycle skills

We give priority to camps that plan to use the trailer every day of the loan period, use the bikes for after camp programs, and do a culminating ride or event.

Name of Organization
What is the name of the organization running the camp?
Your answer
Town where camp is located
Your answer
Contact person
Your answer
Phone
Your answer
Email
Your answer
Do you have a staff person trained on the Bike Smart curriculum?
Only a Local Motion training or one led by Safe Routes to School are eligible
Required
Will this Bike Smart-trained staff person train the rest of your staff?
The program works best when all involved staff are trained on the curriculum.
Required
Does your town have more than 50% low-income residents? Does your camp serve children from low-income households?
We prioritize camps that serve large numbers of lower-income families. If your camp does not meet this criteria- DON'T WORRY! We use other criteria as well to determine whether to bring our trailer to a camp.
Required
County where camp is located
We charge a nominal fee to help cover fuel costs for deliveries. See our website for details. (www.kohlskidsbikesmart.com)
How many weeks do you need to have the trailer?
Enter your "bare minimum" here, but if you would like more (and have plans to do great things with the trailer), let us know how many weeks you dream of having in the "description of plans" section.
Preferences regarding dates
*make sure you indicate a choice for each week, or the form will give you an error* Please let us know if there is a specific week or weeks that would work significantly better for you. If these dates would allow you to train more kids, please say so in your description of your plans.
Yes
No
If Need Be
June 26-30
July 3-7
July 10-14
July 17-21
July 24- 28
July 30- August 4
August 7-11
August 14-18
August 21-25
Number of participants in camp
Indicate the approximate TOTAL number of kids you expect will participate in camp bike skills trainings you offer. For example, if your camp has 8 groups of 10 campers, and you expect each group to participate in bike skills trainings over the week, then choose 80 campers).
Hours per camper
For example, if each child will participate in trainings for four 30-minute sessions that would be 2 hours per participant.
Number of participants in after-camp trainings
If you offer an before or after camp care program, and plan to offer bike camp during these programs, indicate the average attendance you expect for your after camp program during the training week. (This assumes all after camp participants will take part in bike skills trainings. If this will not be the case, indicate the average number you expect to participate each day.)
Hours per after camp training participant
For example, if each child will participate in trainings for four 2-hour sessions, that would be eight hours per participant.
Description of plans
Please tell us a little more about what you'd like to do with the equipment. The more you can get done in the time you request, the higher priority your camp will have. For example, a camp that dedicates all of camp time to bike skills, does a week-long after-camp biking module, and finishes up with a Friday bike celebration will get top priority!
Your answer
Will you need adaptive gear?
If you think that you may need adaptive bikes or equipment for some of your campers, we need to know about the need well in advance in order to be able to find some for you.
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