Request a Bike

Please fill out the form below if you are in need of a bike through our Bike Match for Kids program.

If a match is found, you will be contacted to arrange to pick-up of the bicycle. Usually this will take place at the Bike Coalition’s office. Currently the exchange will be a no-contact exchange observing social distancing guidelines.
Filling out this form does not guarantee you a bike.
Matches are made based on inventory, fit, and need.

Covid-19 Precautions

If you have a fever, cough, or COVID-19, or have been exposed to someone who has a fever, cough, or COVID-19, please self-quarantine and refrain from participating.
For sanitary purposes, all bike exchanges are permanent.

Parent’s Name

Youth’s Name *

Email *

Phone *

Zip Code *

Neighborhood *

Youth’s Height

Feet *

Inches *

What Kind Of Bike Do You Prefer?

How Will A Free Bike Help the Youth?

Help us understand the circumstances and how the youth may use the bicycle – ride to school, etc. The more information you provide the easier it is for us to match a youth with a bike. (Max 100 words)

If matched, the youth *

agrees

declines

to attend a bike safety class or bike rodeo (offered FREE from the Bike Coalition).

If matched, I *

agree

decline

to upload a photo and story with the new bike to help inspire more people to participate in bike match.

I have *

read and agree

to the Bike Match for Kids Liability Waiver

Bike Match for Kids is funded by:

REQUEST A BIKE

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