2024 SPD Christmas Bicycle Program Registration

Christmas Bicycle Program Registration
The Salisbury Police Department will be partnering with Randy Marion Auto Group in the pair's first Christmas Bicycle Prograrn. This program provides bicycles for less fortunate children in the City of Salisbury. It is our desire to give bikes to those who couldn't otherwise be able to receive this gift.

To be eligible to receive a bicycle, the child must reside in the City of Salisbury, be between the ages of 5-14, and be present at the residence on the delivery day. This application must be completed in full. The number of bicycles to be given out is limited and preference will be given to children of families who are in the most need of assistance. Applications are for families who have never qualified for a bicycle from the program. Completing this form does not guarantee you will receive a bicycle.

IF YOU ARE SELECTED FOR THE PROGRAM, YOU WILL BE NOTIFIED OF ACCEPTANCE AND ARRANGEMENTS FOR DELIVERY WILL BE DISCUSSED. Please do not call the Salisbury Police Department. We will call you.

*Applications must be completed in full, with a direct, working phone number on which we can reach you or your application will be disqualified. Failure to complete the application with factual and accurate information will result in disqualification of the application. All applications must be completed by Friday, November 8, 2024. Salisbury Police reserve the right to close the application before Friday, November 8, 2024, if we reach capacity.
Your Information
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number (Daytime Number)*

Area CodePhone Number
Income Information

(All information will be verified.)
Employer
Gross Income ($)
Social Security/Disability ($)
Unemployment ($)
Food Stamps ($)
Welfare ($)
Child Support ($)
Other Household Incomes ($)
Have you ever received a bicycle in the past from this program?*

YesNo
Did you receive holiday assistance last year from any organization?*

YesNo
Are you receiving any holiday assistance this year from any organizations?*

YesNo
Child Information
General Bike Sizes For An Average Size Child:

(It is your responsibility to choose a bike that is safe for your child. If uncertain, please test your child's size at a local store.)

16 inch = 5-6 years old or small child of 7 years old (equipped with training wheels)

20 inch = 7-10 years old

26 inch = 11-14 years old

**Children 15 years and older will not be given bikes.
Child/Children's Information*
If your application is accepted and we deliver a bicycle(s) to your residence, Randy Marion Auto Group has requested we photograph your child receiving the bike from officers of the Salisbury Police Department. These photographs may be used for an article in the Salisbury Post. The following is a photograph release statement that is REQUIRED before we can use the photograph of your child. lf you do not want your child photographed, please check the appropriate box.
Do you authorize the use of photography of your child/children for the purposes of this program?*

YesNo
I authorize the Salisbury Post to use, my name or my child's name and likeness in a photograph or promotional material relating to the same, released or shown by the Salisbury Post. I understand and agree that neither I, nor my heirs, executors, administrators, and assigns shall be entitled to any compensation for the use of my name or my child's name and likeness by the Salisbury Post. The below listed children are in my care and are to be covered under this release.*

Clear
Should be Empty:

Christmas Bicycle Program Registration

Your Information

Income Information

Child Information