DRES Bike Request Form 2021

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Please fill out the following information to apply to receive a bicycle on a Free Bikes4Kidz 2021 Giveaway Day, December 11 at 6100 Merriweather Drive in Columbia.

Forms must be received by 11/10/21

We work to fulfill as many requests as possible, but please note that filling out this form does not guarantee a bike. Requests will be filled as best as we can, based on our inventory.

Parent Name

Student Name *

Age *

Height (Feet and Inches) *

Gender *

Boy

Girl

Don't care

Other:

Bike Speed *

Single speed

Multi speed

Don't care

Email *

Phone # *

Zip code *

Child knows how to ride a bike

Yes

Clear selection

I understand the child will be fitted with a helmet at bike pick up. Type parent name. *

Submit

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