Bicycle Repair Workshop Form

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Safe Routes to School

To schedule a bicycle repair event at your school, please fill out the information below. This 2-hr event is geared to engage parents and students in bicycle safety education. During the event, students will learn how to make minor repairs to their own bicycles, will receive a bicycle helmet (if needed) with fitting instructions, and receive bicycle and pedestrian safety activity books. Students in elementary school must be accompanied by an adult.(Only scheduled on Monday, Wednesday). Any cancellation will need to notify SRTS 3 days prior to event.

Name of Person making request *

School Name: *

Name of Contact person coordinating the event: *

Contact person's phone number: *

Contact person's email address: *

Event Date request *

YYYY

Event Time requested (in 2hr increments) *

Time

We need the following items to conduct the event. Please check the items your school will be providing. *

2 Tables

2 Chairs

Required

Velofix, a mobile repair vendor, will be conducting the repairs. A Safe Routes to School liaison will assist with the event. They will need to set up somewhere on the blacktop where enough space is available.

Confirmation will be sent by email.

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