Bike Works · Bikes-For-All! Application

You must live in one of our qualifying zip codes to recieve a bicycle: 98106, 98108, 98118, 98134, 98144, 98168, 98178

Please select your zip code *

Bikes for All! provides bicycles to youth, adults, & families who currently live or reside within our strategic planning target area of southeast Seattle, Washington. By living within one of our zip codes (98106, 98108, 98118, 98134, 98144, 98168, 98178), you certify that you meet this residency requirement. If you do not live within one of above zip codes, you are not eligible to receive a bike through Bikes-for-All! Thank you for your understanding.

98106

98108

98118

98134

98144

98168

98178

Not listed

Are you currently experiencing homelessness?

Yes

No

Prefer Not To Answer

Residency requirement not met

Sorry, your zip code is outside of the Bikes-For-All service area. We cannot fulfill your application at this time.

I am *

Other *

Do you currently own a bicycle? *

Yes

No

Referring Organization

If you are applying by recommendation or referral from an organization, or a representative of an organization applying for bikes on behalf of folks you serve, please list the name of that organization here.

What is the best way to contact you? *

Phone

Email

Contact Information

Name *

First Name

Last Name

Phone *

Email *

Verify Email *

Address

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Date of Birth *

(mm/dd/yyyy)

Race/Ethnicity *

Gender Identity

Which of the following best describes your socioeconomic experience?

More info about class distinctions here: https://resourcegeneration.org/breakdown-of-class-characteristics-income-brackets/

Underemployed/underpaid; basic living expenses might be impossible/difficult to obtain; unstable housing (20% of the U.S. population)

Employed with limited access to savings, benefits, or flexibility in hours or pay; rental housing (40% of the U.S. population)

Depends on salary to pay bills, may have mortgage or education debt; access to college education; home ownership or rental (20% of the U.S. population)

Savings/investments may allow for early retirement; may receive or give inheritance; little to no debt; access to college education; managerial or professional employment; home ownership (19% of the U.S. population)

Assets make full-time work optional; may receive or give large inheritance; no debt; access to prestigious education; managerial or professional employment; ability to be generously philanthropic; home ownership. (1% of the U.S. population)

How many bikes are you applying for? *

Please list the AGE & HEIGHT of each person you are requesting a bicycle for: *

KIDS BIKES: If you would like to request training wheels on any kids bikes, please let us know here. We will try our best to accommodate requests, but cannot guarantee anything.

Please list any considerations we should know about. (Health issues, injuries, disabilities, etc.)

Please write a personal statement about your need for a bicycle:

If you qualify for a bike, can you come pick it up at Bike Works? *

We are located in Columbia City on South Hudson Street, right off of Rainier Ave.

Yes, I can come pick up my bike(s)

No, I am unable to pick up my bike(s)

Medical Release and Release from Liability

Assumption of Risk:

I am aware of inherent and other risks involved in my participation in the program (including but not limited to, injury, death, or property damage) and I hereby assume any and all risks, whether known or unknown to me at this time that may result from my participation in the program. I understand that if something happens to my bicycle while it is being stored on the premises or while on a ride with Bike Works that they will not be liable to repair or replace it.

Release from Liability:

I hereby release Bike Works, its directors, officers, agents, representatives, employees, and contractors from and against any and all claims, or damages arising out of or in connection with my participation in the program. This release includes, without limitation, any claims arising in negligence, advice on bike repair, or other.

Hold Harmless and Indemnity:

I hereby agree to defend, indemnify and hold harmless Bike Works, its directors, officers, agents, representatives, and contractors from and against any claims, damages, liabilities, costs and expenses (including, without limitation, reasonable attorney’s fees) arising out of resulting from or incurred connection with my participating in the program.

Acknowledgement:

I understand that Bike Works, its staff and all persons related directly or indirectly with the program assume no financial obligation or liability.

By submitting this form you certify that:

All of the above information is correct to the best of my knowledge.
I understand that completing this application does not guarantee that I will receive a bike. My application may be rejected if I reside outside of Bike Works' service area, if I fail to provide accurate contact information, or if I fail to respond to communications from Bike Works about my bike.
I understand that if I receive a bike, it is not under warranty and cannot be exchanged or replaced, nor is it eligible for free repairs or services.
I understand that I may only receive 1 bike per year through this program.
I understand that once Bike Works has contacted me about receiving a bike, I will have 10 business days from the date of contact to confirm a pickup/dropoff time.

*

I certify that I am 18 years of age or older and meet the requirements for this program.

*

If you would prefer a paper application you can fill one out at Bike Works.

I consent to sign this application electronically.

Signature *

Date *

(mm/dd/yyyy)

Suggested Donation

As a nonprofit, bike giveaways are made possible through our fundraising efforts. If you are able, consider making a donation to help keep this program running.