JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
VB New Student Questionnaire 2023
HEADS UP!
You've landed on an OLD, closed version of the New Student Questionnaire.
Please follow
THIS LINK to the 2024 FORM
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Before you begin...
• Sorry kids! Virtuous Bicycle offers lessons for adults and mature teens.
• If you're thinking of giving VB lessons as a gift, see
https://www.virtuousbicycle.com/BlogSpace/gift-certificates/
CONTACT INFO
Full and accurate info is needed for registration
Your Name
*
Full first & last name for use on forms
Your answer
My friends call me...
How would you like us to address you?
Your answer
Address
*
Please provide complete address for use in billing and for Forms / Waiver
Your answer
Cell phone
*
We need this in case of some delay on lesson day.
Your answer
Email
*
Your answer
Check your email address for typos
*
Confirmed! Thanks for not making me type it twice ;-)
Required
STUDENT PROFILE
Are you a steel welder or are you a teacher? Are you in college or are you working your bucket list? Our students are not all alike, and we want to plan lessons that will meet your needs.
What's your age?
*
Virtuous Bicycle offers lessons to Adults and mature teens
I'm at least 13, but not yet 18 years old
College age
Late 20's
30 something
Closer to 40
40 something
Closer to 50
50 something
While there's no cut-off, age is certainly a factor in your overall profile. Please click "Other" below, and enter your actual age.
Other:
How tall are you?
*
To gauge bike fit
Your answer
What type of work do you do?
It's a lifestyle question. General answers are fine, eg "I work in publishing", or "Construction"
Your answer
Exercise and Sports
*
Fitness classes, yoga, dance, basketball, tennis, hiking... Do you now, or did you ever, enjoy any sports or exercise? Give details!!
Important:
How long has it been?
Your answer
Skills you've practiced, things you're good at, something you're proud of!
Past learning experiences can help us understand the learning process as it applies to gaining biking skills today.
Your answer
PERSONAL QUALITIES
Indefinable traits that impact on your ride
Klutz Index
*
definition: Klutz - a clumsy or awkward person.
I'm as graceful as a cat!
1
2
3
4
5
6
7
8
9
10
I'm a complete Klutz
Potato Index
*
Fitness Buff
1
2
3
4
5
6
7
8
9
10
Coach potato
Excess Weight
*
Hey, we could all stand to loose a few ;-)
My weight is Perfect
1
2
3
4
5
6
7
8
9
10
Serious excess weight
Do you drive a car?
*
Check ALL that apply
No, I've never had a license
I used to have a license
I have a license, but rarely drive
I drive occasionally
I drive regularly
I would rather let someone else drive
I'm a terrible driver
I enjoy driving and drive whenever I have a chance
N/A, I'm too young
Required
Pedals
*
Riding a bike involves controlling your legs as they go round and round. How familiar are you with pedaling?
(Check one, or describe in your own words)
I exercise on a stationary bike (spin class or home machine) all the time!
Throughout my life, I've had various pedaling experiences
I've used a stationary bike once or twice
There was probably something from my childhood, but that's about it
No, I've never used a device with pedals
Other:
Access to stationary bike
*
Don't worry if you the answer is "No", but if you have access to a stationary bike, you can get a head start with some pre-lesson homework.
Yes! I have access to a stationary bike!
No, I don't have access to a stationary bike.
Other:
BICYCLING HISTORY
Theres always a story: from your childhood, from when your best friend promised he could teach you, or from that group class that somehow didn't work for you. Please don't be shy! Your experiences around bikes may seem inconsequential to you, but in terms of guiding your instruction, there's little that's more important.
Your biking ability
*
Check ALL that apply. You may add details in "Other".
I've never-ever tried to bike
I tried, but never "got it"
I tried, had some success, but never followed through
I rode as a kid, but have no confidence in my current abilities
I can ride, but I'm not great at it
I ride ok and have a specific goal (eg; biking on vacation, extending my mileage, prepping for a triathlon)
I ride very well
Other:
Required
Checkboxes can't always capture the whole story - please expand on your selections about your biking history
Take all the space you need
Your answer
Do you own a bike?
Tell us about it
Your answer
What would you like us to know that we haven't asked?
Now's you chance to tell your story and express your concerns.
Your answer
BICYCLING GOALS
I want to learn because . .
*
Why now? Is there some specific reason you're seeking Learn to Ride lessons today?
Your answer
SCHEDULING
I'm available for Virtuous Bicycle sessions...
*
Check all that are possible - not just your first preference.
On weekends (Difficult)
On weekdays (RECOMMENDED)
Anytime at all
It's complicated (tell me more in the space provided):
Other:
Required
Deadlines
*
HEADS UP! Plan ahead! Lessons are rarely available on short notice. Please select an option, then PROVIDE DETAILS in "other".
I need a lesson in the next few days! After that, forget it.
I have a time-sensitive goal, but it's a few weeks out. (Describe Goal and Dates in the space "other")
I want to take advantage of a window of opportunity in my schedule. (enter your DATES in the space "other")
I don't have a deadline, but now that I've found you, I do want to do this asap!
Hey, I've waited all my life, a few more weeks give or take, are not going to matter.
Other:
Required
Are you considering an "Extended" lesson?
*
Take a little extra time, go a little slower, progress a little further.
Extended Lessons are appropriate for those who can maintain energy and concentration for 3-hours. For the right student, an EL can make all the difference.
Let's just do a Standard 2-hr Lesson
An Extended 3-hr Lesson sounds like a good idea
Please review my profile and advise me on this idea
PROMOS
Ways to Save
TIP: Most students request / need follow-up lessons. Booking a Series ensures optimal lesson spacing. Plus, there are generous pricing incentives for Series. Scheduling priority will always go to committed students who book a Series.
Book a Series
Clear selection
Are you a Gift Certificate recipient?
Enter your activation code or the email of your gift giver. Everyone else, just leave BLANK.
Your answer
Set your Spam Filter
*
You've taken the time to fill out this form - make sure you receive the response! Reports from disappointed applicants found my response in their junk folder. Take a minute and add "Lance@VirtuousBicycle.com" to your spam filter's Approved list. (I'm lookin' at you @Yahoo, @Hotmail and @AOL people!)
Thanks, I'll do it now.
Required
We're done. Are you glad?
*
Oh my yes! Very glad!
Required
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms