VB New Student Questionnaire 2025

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THANK YOU FOR YOUR INTEREST in private lessons with Virtuous Bicycle. We believe that success in cycling is a self-perpetuating loop, a "virtuous cycle". A skilled rider enjoys biking, so they ride more! With each ride, their fitness and confidence grow, leading to the ultimate benefit — a lifetime of cycling enjoyment.

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

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

Congratulations, you're about to take your first step on a lifetime journey toward the rewards of riding a bike.

Thank you for trusting Virtuous Bicycle,
Lance Jacobs
Virtuous Bicycle

NYC

Before you begin...

This Form is for adult students, applying for their own lessons.

• For Minor Students (not yet 18 yrs), use: Minor Student Application

• For Gift Certificates, use: Gift Certificate Order Form

No junk mail

Virtuous Bicycle does not do junk mail – there is no mailing list. The information you provide will be used for planning your lessons – end of story.

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

Cell phone *

We need this in case of some delay on lesson day.

Email *

All booking and lesson planning will be handled through email. Be sure to use your most reliable address.

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 lessons that will meet your needs.

What's your age? *

Virtuous Bicycle offers lessons to Adults and mature teens

Minor students 13–17 yrs: Please use the MINOR FORM

College age

Late 20's

30 something

Closer to 40

40 something

Closer to 50

50 something

While there's no cut-off, age is certainly a factor in your overall profile. Please click "Other" below, and enter your actual age.

Other:

How tall are you? *

Virtuous Bicycle is able to offer lessons for students 5'0" and taller.

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!

Music, sailing, foreign language... 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

Pedals *

Many biking operations involve your feet and legs. How familiar are you with pedaling? (CHECK ALL THAT APPLY)

I exercise on a stationary bike (spin class or home machine) all the time!

Throughout my life, I've had various pedaling experiences

I've used a stationary bike once or twice

There was probably something from my childhood, but that's about it

No, I've never used a device with pedals

Other:

Required

Access to stationary bike *

Don't worry if you the answer is "No", but if you have access to a stationary bike, you can get a head start with some pre-lesson homework.

Yes! I have access to a stationary bike.

Pre-lesson homework sounds great! This is exciting!

I probably won't have time for pre-lesson homework :(

No, I don't have access to a stationary bike.

Other:

Required

BICYCLING HISTORY

Theres always a story: from your childhood, from when your best friend promised to teach you, or from that group class that somehow didn't work for you. Please don't be shy! 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 now? Is there some specific reason you're seeking Learn to Ride lessons today?

SCHEDULING

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

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

On weekends (Difficult)

On weekdays (RECOMMENDED)

Anytime at all

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

Other:

Required

Deadlines *

HEADS UP! Plan ahead! Lessons are rarely available on short notice. Please select an option, 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 the space "other")

I have a window of opportunity as I'll describe 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.

Extended Lessons are appropriate for those who can maintain energy and focus for 3-hours. For the right student, an EL can make all the difference.

An Extended 3-hr Lesson sounds like a good idea

Let's stick to Standard 2-hr Lessons

Please review my profile and advise me on this idea

PROMOS

Ways to Save

TIP: Most students request / need follow-up lessons. Booking a Series ensures optimal lesson spacing. Plus, there are generous pricing incentives for Series. Scheduling priority will always go to committed students who book a Series.

Book a Series

Clear selection

Gift Certificate recipients

Enter your activation code or the email of your gift giver. Everyone else, just leave BLANK.

Set your Spam Filter *

You've taken the time to fill out this form - make sure you receive the response! Reports from disappointed applicants found my response in their junk folder. Take a minute and add "Lance@VirtuousBicycle.com" to your spam filter's Approved list. (I'm lookin' at you @Yahoo, @Hotmail and @AOL people!)

Thanks, I'll do it now.

Required

We're done. Are you glad? *

Oh my yes! Very glad!

Required

Submit

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