Regional BikeMobile Application

If you have an urgent request please fill out this form and send an email to or call 510-972-4246.


By completing this form you agree to be the coordinator between the BikeMobile Team and the event location, and confirm you are responsible for the following:


1. Coordinate day of event logistics: Identify our setup location, make sure the bathrooms are open, and the entrance is unlocked.

2. Promote the visit with flyers and announcements. We supply you with a flyer template to customize for your event.

3. Greet us the day of the event to show us where to set up and help with intake for the first 30-45 minutes. If you are not available for this task, please find someone to fill this role and share their cell phone # with us.


The event must be:

-- Free of charge or have a 100% fee waiver for youths from low income families.

-- Focused on engaging youths and parents.

-- Able to provide space for our van and canopy. We need a minimum of 2-3 parking spots worth of space. We can set up on the grass, sidewalk, indoors, or blacktop. Ideally, we are able set up our canopy next to our work van. If this is not possible, we ask to be set up as close as possible to the van.

We are limited to serving a maximum of up to 20-40 bikes, depending on how much attention each bike requires. If demand is high, we only allow 1 bike per person. Your site may be eligible for an additional visit if we have the capacity. Sometimes a bike is damaged beyond our ability to make it safe to ride again.
Sign in to Google to save your progress. Learn more
Name of School or Site *
Type of Site *
Street Address *
City *
County *
If you are applying for a visit in Alameda County, please go to this website Otherwise, please continue.
Your Name *
Your Title or Relationship to the Site *
For Example: Parent, Activities Coordinator, Etc.
Your Cell Number *
It's important for us to be able to reach you when we arrive at your location.
Your Email Address *
Principal/Director's Name *
Principal/Director Phone *
1) Is your site, event, or club free to participate in? If not, does it have a 100% fee waiver for low income youths? *
You must answer yes to qualify. If you're not sure if you qualify, please ask us.
2) On average, how many youth bike to your site each day around the timeframe we'll be visiting? *
3) Are other bike shops attending your event? *
If so, please let us know their name.
4) The Bikemobile can stand alone or tie into an existing event. Which are you interested in? *
If you want it to link to an existing event, please describe the event in the blank labeled "other"
5) Will you be available to greet us at the event and help with intake? *
If someone besides you will be available to help, please put their name AND cell phone # in the "Other" box
6) We make visits Tuesday through Sunday for 3 to 4 hours. Please provide 3 possible dates AND TIMES you would like us visit in order of preference . *
7) Who referred you to the Bikemobile? *
Please include their name and organization.
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy