Amazing Gracie's Great Bike Giveaway Entry Form
We are reaching out to meet the needs of special needs families. If you are a special needs family and bikes would be helpful to the siblings of your special needs child, please apply here. DEADLINE: May 15, 2017
Email address
Parent's Name
Your answer
Phone Number
Your answer
Mailing Address (entire address)
Your answer
Please list the children in need of a Bike (please provide the following for each: 1) Name 2) Age 3) Gender
Your answer
What size bike would each of your children prefer?
Tell us your story...
Your answer
By selecting this box, you agree that if selected, photos of your family and the likeness, thereof, can be used for promotion of Amazing Gracie's Legacy and the events that we sponsor.
Required
By selecting this box, you agree that Amazing Gracie's Legacy and all parties associated with this non-profit hold no liability associated with any and all bike(s) and equipment that you and your family receive.
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A copy of your responses will be emailed to the address you provided.
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