Dear Parent(s)/Guardian(s), The bicycle giveaway is an annual event. It is scheduled for Saturday, December 18, 2021. If your child received a bike from the Bicycle-Man on April 24, 2021, please do not apply. To qualify for this program your family must be receiving assistance from one of the following sources: Free/Reduced lunch at school, Food Stamps (EBT), Work First services, Medicaid services, or SSI. You could also qualify if you have been identified for Homeless Services (McKinney-Vento Act [MVA]) or be able to demonstrate financial hardship. The limit is two (2) bicycles per family no exceptions. There is a required donation of $5.00 per bicycle to be paid on the day of pick-up, no exceptions. Your child/ren cannot turn 15 before December 25t, no exceptions. If you want a bike for your child/ren please fill out this form and return it to the Program Administrator/Day Care Director/Family Advocate/School Social Worker at the facility your child/ren attends no later than Friday, November 12, 2021. Once your application is processed and approved, you will receive a gift certificate with instructions on where to bring your child/ren to pick up the bike.