Friendship Bike Application | FCC

Friendship Bikes
Application

First name

Last name

Date of Birth

Month

Day

Year

Height

Address

City

State

Zip Code

Phone Number

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)

Purpose of Bicycle Request

Bicycle Use & Safety Acknowledgement

(Initial Each)

I understand that riding a bicycle involves inherent risks.

I understand that I am responsible for operating the bicycle safely and lawfully.

I understand that Friendship Bikes does not provide ongoing maintenance.

I understand that helmet use and traffic law compliance are strongly recommended.

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.

Signature

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Medical & Physical Fitness Statement

(Initial Each)

I am physically capable of riding a bicycle.

Friendship Bikes does not evaluate my medical fitness.

Applicant Certification

Applicant Signature

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Date

Month

Day

Year

If Applicant is Under 18:

Parent/Guardian Name

Parent/Guardian Signature

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First Christian Church
(Disciples of Christ)

Friendship Bikes
Application

Purpose of Bicycle Request

Bicycle Use & Safety Acknowledgement

Release of Liabilility & Assumption of Risk

Medical & Physical Fitness Statement

Applicant Certification

PHONE NUMBER

(580) 762-1667

ADDRESS

First Christian Church
210 N 5th St
Ponca City, OK 74601

SOCIAL MEDIA

Facebook
YouTube

Friendship Bikes Application

Purpose of Bicycle Request

Bicycle Use & Safety Acknowledgement

Release of Liabilility & Assumption of Risk

Medical & Physical Fitness Statement

Applicant Certification

PHONE NUMBER

(580) 762-1667

ADDRESS

First Christian Church 210 N 5th St Ponca City, OK 74601

SOCIAL MEDIA

Facebook YouTube

Friendship Bikes
Application

First Christian Church
210 N 5th St
Ponca City, OK 74601

Facebook
YouTube