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Ride with Level Pedals
Request form to ride with Level Pedals on a route or trail of your choice.
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* Indicates required question
Full Name
*
Your answer
Email Address
*
Level Pedals won't share your email with anyone. We'll reach out to you via email for any follow up questions or to coordinate a ride.
Your answer
City or County of Residence
*
This information will not be shared with anyone outside of the organization. All information on this form is confidential and will only be presented in aggregate format. For example, Level Pedals did 7 rides in San Juan County.
Your answer
Which race do you self-identify as?
Optional, though Level Pedals would appreciate this information
White
Black or African American
Asian American
American Indian/Alaskan Native
Native Hawaiian/Pacific Islander
Northern African/Middle Eastern
Multi-racial
Other:
Clear selection
What age range do you fall in?
Optional. If you are riding as a family, please select more than one.
0-14 yo
15-24 yo
25-64 yo
65+ yo
Which gender identity do you most identify with?
Optional, though Level Pedals would appreciate this information
Female
Male
Other:
Clear selection
What is your household income?
Optional, though Level Pedals would appreciate this information
Less than $20,000
$20,000-$34,999
$35,000-$49,999
$50,000-$74,999
$75,000-$99,999
$100,000+
Clear selection
Why should Level Pedals ride with you?
*
Let us briefly know who you are (e.g. family, retired, etc.) and what we can learn or better understand from experiencing this ride with you.
Your answer
Describe the ride!
*
Style, conditions, length, etc.
Your answer
Have you ridden this route before?
*
Frequently
A handful of times
Never and I'd love some company!
Other:
What type of bike will our staff need to do the ride?
*
Level Pedals will try our best to ride a similar cycle as you.
Your answer
Will you need us to provide you a cycle?
*
Level Pedals recognizes access to a functional cycle is a challenge. Please let us know if you need us to provide you a cycle to ride your route.
Yes
No
Other:
Will you need us to provide temporary health insurance and/or extend liability coverage to you for the ride?
*
Level Pedals recognizes being under or uninsured can be a barrier to riding on the road or trail. Let us know if you would like coverage for the ride and we'll have you complete a separate form.
Yes
No
Other:
And lastly, what are some date/time ranges you are available for the ride?
*
Level Pedals will try their best to schedule you in. We'll come to you when it's convenient for you.
Your answer
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