BIAWW Request for Free Children's Helmet
Welcome to the Brain Injury Association Waterloo-Wellington (BIAWW) Bike Helmet Give Away request form. Please fill out this form and indicate the size of helmets required for EACH child.

Once you submit this form, you will get a copy of your responses. A couple of days prior to the event, you will receive an email reminder with the pickup details. Please check your junk/spam folders for BOTH of these emails.
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Email *
Parent or Guardian's First Name
 *
Parent or Guardian's Last Name
 *
Phone Number *
Size of helmet (Toddler, Small, Medium, Large). Please use the chart below to measure child's head based on age and head circumference prior to selecting size.
Size for each child? Please measure the circumference of your child's head! Similar to measuring feet for correct shoe size, measuring their head is essential for a proper fitting helmet.
Toddler (48-51 cm)
Small Waitlist
Medium Waitlist
Large Waitlist
Child 1
Child 2
Child 3
Clear selection
Age range for each child:
2-4 years
5-9 years
10-14 years
15-16 years
Child 1
Child 2
Child 3
Clear selection
Do you need more than 3 helmets? We will contact you!
Clear selection
Street Number *
Street Name *
Apartment/Unit Number
City *
Postal Code *
Pickup Location *
A copy of your responses will be emailed to the address you provided.
Submit
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