VB New Student Questionnaire 2022
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 their rides and rides more. With each ride, their fitness and confidence grow, leads to the ultimate benefit — a lifetime of cycling enjoyment.

• 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 planning details.

• 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 toward the fun and rewards of riding a bike.

Thank you for trusting Virtuous Bicycle,
Lance Jacobs
Virtuous Bicycle

__________________________________________________________________________________________
Note about this Google Form:
If you're signed in to a Google Account, your email address will be shown below. This just tells you which Google account you're signed in to. Pretty much, just ignore it.

Also, the red "*Required" alert is not related to your email at all - it's just the standard indicator that a starred question is required.

Sign in to Google to save your progress. Learn more
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
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
Cell phone *
We need this in case of some delay on lesson day.
Email *
Check your email address for typos *
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
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
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".
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 . . *
What is your motivation in seeking Learn to Ride lessons? Why now?
SCHEDULING
I'm available for Virtuous Bicycle sessions... *
Check all that are possible - not just your first preference.
Required
Deadlines *
HEADS UP! Plan ahead! Lessons are rarely available on short notice. Please select an option, then PROVIDE DETAILS in "other".  
Required
Are you considering an "Extended" lesson? *
Take a little extra time, go a little slower, progress a little further.
COVID-19
COVID Protocols *
Covid guidance is constantly changing. VB posts current policies at VirtuousBicycle.com > Covid-19 Status. Be sure you're clear and in agreement with our current policies.
Have you received Covid-19 Vaccination? *
For 2022, we'll continue to require vaccination
Required
PROMOS
Ways to Save
Programs to help you save on the cost of private lessons. See website for details on these promos.
Clear selection
Set your Spam Filter
Recent reports from disappointed applicants found my response email 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 and @Hotmail people!)
We're done. Are you glad? *
Required
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy