Need a Bike?

Need a Bike? Let us know.

Your First name*
Your Last name*
Your Phone Number*
Your Email*
Your Address*
Street Address Address Line 2 City State ZIP Code
Number of Recipients:*
Name of Recipient #1:*
First Last
Age*
Height*
Height of bike recipient in feet and inches. Example 4' 8"
Does this person have their own helmet?*
Name of Recipient #2:*
First Last
Age*
Height*
Height of bike recipient in feet and inches. Example 4' 8"
Does this person have their own helmet?*
Name of Recipient #3:*
First Last
Age*
Height*
Height of bike recipient in feet and inches. Example 4' 8"
Does this person have their own helmet?*
Name of Recipient #4:*
First Last
Age*
Height*
Height of bike recipient in feet and inches. Example 4' 8"
Does this person have their own helmet?*
Name of Recipient #5:*
First Last
Age*
Height*
Height of bike recipient in feet and inches. Example 4' 8"
Does this person have their own helmet?*
*Not all bikes will come with training wheels.
By submitting this registration, I authorize Sarah Jane Johnson Memorial UMC to use any family member's photograph in all public and marketing materials.
Anyone 17 years of age or younger must be accompanied by a parent or legal guardian to sign documents.
Name
This field is for validation purposes and should be left unchanged.