Lock, Helmet & Replacement Bike Requests
Please fill out this form to request locks, helmets and bikes for students. These can be for specific students or to have on hand at your school in case there is a student need. The bikes are intended to be for students who have had a bike stolen and cannot replace it. Items are purchased by the 4J Safe Routes to School Program with a grant from the Eugene Education Foundation. Contact Sarah Mazze at mazze_s@4j.lane.edu or (541) 516-0887 with any questions.
Email *
What school is this for? *
What is your name? *
How many of each item are you requesting?
1
2
3
4
5
10
U-Lock
Helmets
Replacement Bikes (for students who have had a bike stolen)
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If requesting helmets, please estimate sizes or share the students' ages
If requesting a replacement bike, please share the students' name, age, gender and height
Will the student be using these items for transportation, recreation, both, or unknown?
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