Go Cycle Bike Loan Scheme - Application Form
Once you have completed this form to register for the Go Cycle Bike Loan Scheme. we will contact you as soon as possible about getting your bike.
If you can see a 'REQUEST EDIT ACCESS' message above this form, please ignore it - you do not need to 'edit' the form, simply complete and submit it.
NB. Your completed form and its contents ONLY be used for the purpose of processing your booking for the Bike Loan Scheme unless you agree to participate in the User Survey.
The Royal Borough of Kingston is working with Kingston University to conduct a survey of the GoCycle Bike Loan Scheme to help us improve our services. As a user of the Bike Loan Scheme we would like to ask if you would agree to Kingston University contacting you to ask about your experience the Cycle Loan Scheme as part of this survey.
Name and Contact Details
Phone / Mobile Number
Address Line 1
Address Line 2
Town / City
Personal Details and Cycling Experience
Please note that you must be over 18 to be loaned a bike
What is your approximate height in cm?
How would you describe your current level of cycling experience?
Non-cyclist (I never cycle or am new to cycling)
Occasional cyclist (I cycle less than once a week, but within in the last year)
Regular cyclist (I cycle at least once a week)
Do you have any long standing illness (i.e. more than 12 months and likely to continue) or do you have a disability which affects or limits your day to day activities?
Prefer not to say
If yes, please provide brief details of your disability
Please select the type of bike you would like to try:
Standard bike (mens style)
Open frame bike (ladies style)
Folding bike (can be taken on public transport at any time)
Open frame bike
Where will the bike be stored at home?
Securely within house or flat
Within a locked garage, shed or similar
On a balcony above ground level
In a sideway or space not accessible to passers by
On the street or pavement (on view to passers by)
If taking the bike to work where will it be stored?
In a secure area within my place of work
In a non-secure area within my place of work
On the pavement or street
Will you be leaving the bike at a station?
What are the main reason/s for loaning a bike?
Please tick all that apply
Increasing levels of physical activity/ fitness
Help manage a long standing illness/ condition
Improving general health and well being
Meeting new people
Learn something new
Develop confidence in cycling
Save money by reducing transport costs
Get from A to B quicker
Spending time with family and friends
Want to take part in an organised cycling event (e.g. RideLondon FreeCycle)
How did you hear about the scheme?
Cycle Kingston website
TV / News (digital or print)
Page 1 of 1
Never submit passwords through Google Forms.
This form was created inside of RBK, LBS and AfC (unifiedgov.co.uk).