VB New Student Questionnaire 2021

COVID PLANS
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WE'RE OPEN!

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.

Lance
March 5, 2021
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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

Before you begin...

• Virtuous Bicycle offers lessons for adults and mature teens.

• If you're thinking of giving a lesson as a gift, see
https://www.virtuousbicycle.com/BlogSpace/gift-certificates/

CONTACT INFO

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 *

Confirmed! Thanks for not making me type it twice ;-)

Required

STUDENT PROFILE

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

I'm at least 13, but not yet 18 years old

College age

Late 20's

30 something

Around 40

Closer to 50

50 something

closer to 60

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.

PERSONAL QUALITIES

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

No, I've never had a license

I used to have a license

I have a license, but rarely drive

I drive occasionally

I drive regularly

I would rather let someone else drive

I'm a terrible driver

I enjoy driving and drive whenever I have a chance

N/A, I'm too young

Required

BICYCLING HISTORY

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".

I've never-ever tried to bike

I tried, but never "got it"

I tried, had some success, but never followed through

I rode as a kid, but have no confidence in my current abilities

I can ride, but I'm not great at it

I ride ok and have a specific goal (eg; biking on vacation, extending my mileage, prepping for a triathlon)

I ride very well

Other:

Required

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.

BICYCLING GOALS

I want to learn because . . *

Why have you decided to learn to ride (or to improve you skills)? Why now?

SCHEDULING

I'm available for Virtuous Bicycle sessions... *

Check all that are possible - not just your first preference.

On weekends

On weekdays

Anytime at all

It's complicated (tell me more in the space provide):

Other:

Required

Deadlines *

Please select a checkbox, then PROVIDE DETAILS in "other".

I need a lesson in the next few days! After that, forget it.

I have a time-sensitive goal, but it's a few weeks out. (Describe Goal and Dates in "other")

I want to take advantage of a window of opportunity in my schedule. (enter your DATES in "other")

I don't have a deadline, but now that I've found you, I do want to do this asap!

Hey, I've waited all my life, a few more weeks give or take, are not going to matter.

Other:

Required

Are you considering an "Extended" lesson? *

Take a little extra time, go a little slower, progress a little further.

Let's just do a regular lesson

I think an Extended Lesson sounds like a good idea

Please review my profile and advise me on this idea

COVID-19

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?

I'm happy to follow all Covid safety protocols

No thanks, I'll pass

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.

No vaccine yet

Yes, but I need a few weeks for full immunity to be established

Yes, I got the shot(s) weeks ago, and the time to achieve full immunity has / will have passed

Prefer not to report my Vaccination status

Other:

PROMOS

Ways to Save

Programs to help you save on the cost of private lessons. See website for details on these promos.

Book a Series

Fly Standby

Refer a friend

Early Spring (automatic for dates before 5/15)

Other:

Clear selection

We're done. Are you glad? *

Yes! Very glad!

Required

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