Bikes for Kids of Northern Indiana Bike/Helmet Application Form
Bikes for Kids (BFK) provides brand-new 20-inch bicycles and helmets to economically challenged 2nd graders in Northern Indiana. To see if you qualify for a bicycle and helmet, please fill out this form and return it to us.
Section 1: Parent/Legal Guardian Information
Parent or Guardian Full Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Preferred Method of Contact
Text
Phone
Email
Section 2: Child Information
Child's Full Name
First Name
Last Name
Child's Current Grade
2nd Grade
Child's School Name
Child's School District/County
Marshall County
St. Joseph County
Starke County
Section 3: Eligibility Confirmation
Please confirm that your child qualifies for income-based assistance:
My child qualifies for free or reduced-price school lunch
My household receives SNAP/EBT benefits
My family qualifies under income-based assistance program
Eligibility Attestation (Required)
I confirm that the information above is accurate and that my child qualifies for income-based assistance
Section 4: Bike Distribution
Are you able to attend a bike pickup event in April/May if needed?
Yes
No
Not sure
Section 5: Consent & Acknowledgement
Consent to Contact School (required).
I give permission for Bikes for Kids to contact my child's school to confirm eligibility
I homeschool my child and will provide verification of my child's eligibility by email or direct mail. Email info@bikesforkids.net. Direct mail: Bikes for Kids, Inc., 19329 6B Road, Plymouth, IN 46563
Program Acknowledgement (Required).
I understand that submitting this application does not guarantee a bike/helmet and that availability depends on funding and inventory
Submit Application Below
Submit
Should be Empty: