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Friendship Bikes
Application

Date of Birth
Month
Day
Year

Purpose of Bicycle Request

Please explain why you are requesting a bicycle and how you plan to use it. (Transportation to work, school, medical appointments, errands, or other needs)

Bicycle Use & Safety Acknowledgement

(Initial Each)

Release of Liabilility & Assumption of Risk

I acknowledge that I am receiving this bicycle "as is" with no warranties. I assume full responsibility for use and maintenance. I release and hold harmless Friendship Bikes, First Christian Church, its staff and volunteers from any and all liability or claims arising from use of the bicycle, to the fullest extent permitted by Oklahoma law.

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Medical & Physical Fitness Statement

(Initial Each)

Applicant Certification

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Date
Month
Day
Year

If Applicant is Under 18:

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