Free Bike Program Application

Urban Bike Project - Free Bike Program Application

InstructionsIn addition to completing this form, a letter of reference (available here ) will need to be completed and dropped off at Urban Bike Project during regular hours.

Location: 1908 N. Market Street (entrance is behind the building under the yellow awning) Tuesday and Thursday 6:30-9:00pm.

A PDF version of this file is also available here if you want to print it / fill it out on paper.

Fields marked with an asterisk are required.
Details and EligibilityRequests for free bikes are reviewed once per month. One bicycle per person. Applicants are required to sign a waiver of liability when picking up the completed bicycle. Free bicycles received by youth must be picked up and signed for by an adult. Bicycles not claimed within 1 month of being notified will be given to other Free Bike applicants. Applicants residing within the City of Wilmington receive priority. Filling out this application does not guarantee that a free bicycle will be given.

Applications MUST have the following:
- - Must be referred by a social service agency or community organization.
- - A letter of reference submitted on official letterhead and signed by an agency/organization staff member.
- - Application must be complete with all requested information.

Personal Information

First Name *
Last Name *
Age *
HeightNeeded for bike fit / sizing.
Gender *
Male Female
Referred By: *

Contact Information

Who should we contact when the bike is ready to be picked up? We need at least one contact.
Contact Name 1 *
Contact Phone 1
Contact Email 1
Second contact details.
Contact Name 2
Contact Phone 2
Contact Email 2

General Information

How will you use your free bicycle?
Will you need a lock or helmet? (Subject to availability)
Is there anything else you would like to tell us about?

Verification

Please enter any two digits with no spaces (Example: 12) *
This box is for spam protection - please leave it blank: