VB New Student Questionnaire 2021


Lance has had 2 doses of the Moderna Vaccine. (2nd shot on Feb 26)

Lesson are now being booked for dates beginning mid- April 2021.

When we do our lessons, all appropriate Covid precautions will be practiced: Masks, wiping down bike, hand-sanitizer, working outdoors, and a Covid Questionnaire before every lesson.

March 5, 2021

Thank you for your interest in private bike lessons with Virtuous Bicycle. We believe that success in cycling is a self-perpetuating loop, a 'virtuous cycle'; The more you know, the more you'll enjoy biking and the more you'll ride.

• This questionnaire will ask about you, your history, your goals, and your concerns. Based on your input, we will get back to you with an evaluation and lesson details and options.

• Please allow time for thoughtful completion of this questionnaire. Insincere submissions may not receive a response.

Congratulations, you're about to take the first step of a lifelong journey of bike riding enjoyment.

Thank you for trusting Virtuous Bicycle,
Lance Jacobs
Virtuous Bicycle
Virtuous Bicycle logo
Before you begin...
• Virtuous Bicycle offers lessons for adults and mature teens.

• If you're thinking of giving a lesson as a gift, see
Full and accurate info is needed for registration
Your Name *
Full first & last name for use on forms
My friends call me...
How would you like us to address you?
Address *
Please provide complete address for use in billing and for Forms / Waiver
Phone *
We need this in case of some delay on lesson day.
Email *
Enter it once, but check it twice!
Check your email address for typos *
Are you a steel welder or are you a teacher? Are you in college or are you working your bucket list? Our students are not all alike, and we want to plan a lesson that meets your needs.
What's your age? *
Virtuous Bicycle offers lessons to Adults and mature teens
How tall are you? *
Helpful in planning bike rentals
What type of work do you do?
It's a lifestyle question. General answers are fine, eg "I work in publishing", or "Construction"
Exercise and Sports *
Fitness classes, yoga, dance, basketball, tennis, hiking... Do you now, or did you ever, enjoy any sports or exercise? Give details!! Important: How long has it been?
Skills you've practiced, things you're good at, something you're proud of!
Past learning experiences can help us understand the learning process as it applies to gaining biking skills today.
Indefinable traits that impact on your ride
Klutz Index *
definition: Klutz - a clumsy or awkward person.
I'm as graceful as a cat!
I'm a complete Klutz
Potato Index *
Fitness Buff
Coach potato
Excess Weight *
Hey, we could all stand to loose a few ;-)
My weight is Perfect
Serious excess weight
Do you drive a car? *
Check ALL that apply
Theres always a story: from your childhood, from when your best friend promised he could teach you, or from that group class that somehow didn't work for you. Please don't be shy! Your experiences around bikes may seem inconsequential to you, but in terms of guiding your instruction, there's little that's more important.
Your biking ability *
Check ALL that apply. You may add details in "Other".
Checkboxes can't always capture the whole story - please expand on your selections about your biking history
Take all the space you need
Do you own a bike? *
Tell us about it
What would you like us to know that we haven't asked?
Now's you chance to tell your story and express your concerns.
I want to learn because . . *
Why have you decided to learn to ride (or to improve you skills)? Why now?
I'm available for Virtuous Bicycle sessions... *
Check all that are possible - not just your first preference.
Deadlines *
Please select a checkbox, then PROVIDE DETAILS in "other".
Are you considering an "Extended" lesson? *
Take a little extra time, go a little slower, progress a little further.
COVID Protocols *
Do you agree to wear a mask, sanitize your hands, and inform Virtuous Bicycle if you have been exposed to Covid-19 or are experiencing flu-like or any Covid related symptoms before the lesson?
Have you received Covid-19 Vaccination? *
Reporting your vaccination status is optional—lessons will be offered regardless of your vaccine status. However, if you'll be fully immunized in a matter of weeks, it may make sense to wait.
Ways to Save
Programs to help you save on the cost of private lessons. See website for details on these promos.
Clear selection
We're done. Are you glad? *
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