VB New Student Questionnaire 2018
Thank you for your interest in private bike lessons with Virtuous Bicycle. We believe that success in cycling is a self-perpetuating loop, a 'virtuous cycle'; The more you know, the more you'll enjoy biking and the more you'll ride.

Students contact us with a wide range of ages, levels of fitness, and past biking experiences. The first step in planning your lesson is to learn a little about you as a bicycle student. This questionnaire will ask about you, your goals, and your concerns. Based on your input, we will get back to you with an evaluation and with lesson details and options.

Please allow enough time for thoughtful completion of this questionnaire. Insincere submissions may not receive a response.

Congratulations, you're about to take the first step on your lifelong journey of bike riding enjoyment.

Thank you for trusting Virtuous Bicycle!
Lance Jacobs
Virtuous Bicycle

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/

Basic Contact Info
Your Name *
Full first & last name for use on forms
Your answer
My friends call me...
How would you like us to address you?
Your answer
Address *
Address, City, State, ZIP
Your answer
Phone(s) *
We need this in case of some delay on lesson day. Be sure to indicate cell (c) or home (h).
Your answer
Email *
Enter it once, but check it twice!
Your answer
How did you find Virtuous Bicycle?
A bike shop? A happy VB student? Google? (What was your search term?)
Your answer
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
Gender *
Required
How tall are you? *
Helpful in planning bike rentals
Your answer
What type of work do you do?
It's a lifestyle question. General answers are fine, eg "I work in publishing", or "Construction"
Your answer
Exercise and Sports *
Fitness classes, yoga, dance, basketball, tennis, hiking... Aside from bicycling, do you enjoy any other exercise? Give details!! Important: How long has it been?
Your answer
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.
Your answer
Personal Qualities
Indefinable qualities 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 selection to the previous question.
Take all the space you need!
Your answer
Do you own a bike? *
Tell us about it
Your answer
What would you like us to know that we haven't asked?
Now's you chance to tell your story and express your concerns.
Your answer
BICYCLING GOALS
I want to learn because . . *
Why have you decided to learn to ride (or to improve you skills)? Why now?
Your answer
Scheduling
For details on the PLAN AHEAD for FALL promotions, visit: https://wp.me/P30v7X-1cd
I'm available for Virtuous Bicycle sessions... *
Check all that are possible - not just your first preference.
Required
Deadlines *
Please select a checkbox, 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.
We're done. Are you glad? *
Required
Submit
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