Request for Delivery via Bike
Thanks for your interest in our help with free deliveries by bike, courtesy of your cycling neighbors and Cambridge Bike Safety! We are very happy to help out elderly and other folks in need during this time of Covid-19 danger. Please fill out form below, and we will be back in touch with you once we have volunteers ready to help you.

1. Curbside pickup only: Volunteers will only be able to engage in "contactless curbside pick-up", ie where items have been paid for online or by phone and we are simply picking up items from outside store and delivering to you. You must place and pay for your order before we can pick it up for you.

2. Relatively small deliveries only: Volunteers will be delivering via bike, so when making requests remember that volunteers can only carry a few groceries in a given delivery. (No alcohol delivery.)


We understand that not every COVID-19 carrier is symptomatic, and we cannot completely eliminate risk. With that in mind, we have implemented the following safety guidelines to minimize any potential transmission of the novel coronavirus.  

Volunteers are asked to participate only if they:
- Have not traveled out of the country in the last 14 days
- Are not exhibiting any signs of compromised health (e.g. runny nose, cough, fever, etc.)
- Have not come in contact with someone who has tested positive for COVID-19 in the last 14 days
- Have been practicing “social distancing” -- staying indoors, avoiding crowds, staying 6 feet away from other people if they have gone outside
- Will wear gloves during deliveries
- Are over 18.

Volunteers will make as minimal contact with the recipient as possible upon delivery. They will place items at the door and knock/ring the doorbell and/or call the recipient to inform them that their order has been delivered.
Sign in to Google to save your progress. Learn more
Your Name *
Feel free to provide only your first name or 'Anonymous' if you'd prefer not to give your name
Your email address *
Your phone number *
Do you text on this phone number?
Clear selection
Preferred method of contact *
Requested date of delivery *
What times during the day work well for delivery? *
What store(s) would you like delivery from? *
If you choose 'Other' and write in a grocery store not on the list, please make sure it's a grocery store that offers "curbside" pickup. This is to ensure that volunteers do not have to pay for groceries themselves and minimize time volunteers spend inside stores. For information on how to order from each of these stores see our website:
Would you like this to be a recurring delivery?
Clear selection
What Cambridge/Somerville neighborhood(s) do you live in? *
How large do you anticipate this load being?
Clear selection
This Release and Waiver of Liability releases Cambridge Bike Delivery, Cambridge Bicycle Safety, and each of its organizers. The Requester desires to receive volunteer services from Cambridge Bike Delivery.

1.Waiver and Release: I, the Requester, release and forever discharge and hold harmless Cambridge Bike Delivery and Cambridge Bicycle Safety and its successors and assigns from any and all liability, claims, and demands of whatever kind of nature, either in law or in equity, which arise or may hereafter arise from the services I receive from Cambridge Bike Delivery and Cambridge Bicycle Safety. I understand and acknowledge that this Release discharges Cambridge Bike Delivery from any liability or claim that I may have against Cambridge Bike Delivery and Cambridge Bicycle Safety with respect to bodily injury, personal injury, illness, death, or property damage that may result from the services I receive from Cambridge Bike Delivery and Cambridge Bicycle Safety or occurring while I am receiving volunteer services.

2. Insurance: Further I understand that Cambridge Bike Delivery and Cambridge Bicycle Safety does not assume any responsibility for or obligation to provide me with financial or other assistance, including but not limited to medical, health, or disability benefits or insurance. I expressly waive any such claim for compensation or liability on the part of Cambridge Bike Delivery and Cambridge Bicycle Safety beyond what may be offered freely by Cambridge Bike Delivery and Cambridge Bicycle Safety in the event of injury or medical expenses incurred by me.

3. Medical Treatment: I hereby Release and forever discharge Cambridge Bike Delivery and Cambridge Bicycle Safety from any claim whatsoever which arises or may hereafter arise on account of any first-aid treatment or other medical services rendered in connection with an emergency during my tenure as a Requester with Cambridge Bike Delivery.

4. Assumption of Risk: I understand that the services I receive from Cambridge Bike Delivery may include activities that may be hazardous to me. As a Requester, I hereby expressly assume risk of injury or harm from these activities and release Cambridge Bike Delivery and Cambridge Bicycle Safety from all liability.

5. Other: As a Requester, I expressly agree that this Release is intended to be as broad and inclusive as permitted by the laws of the State of Massachusetts and that this Release shall be governed by and interpreted in accordance with the laws of the State of Massachusetts. I agree that in the event that any clause or provision of this Release is deemed invalid, the enforceability of the remaining provisions of this Release shall not be affected.

By clicking the box below, I express my understanding and intent to enter into this Release and Waiver of liability willingly and voluntarily.
Waiver agreement *
Any other notes / questions
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy