The Digital Flipbook

WMC Holiday Bike Event 2023

Referring Agency *

Child's Name *

Age *

Zip Code *

Caregiver Name *

*A valid I.D. in caregiver’s name must be presented to pick up the bicycle.

Email *

Bike Selection *

Please select if there is a preference for bike style

Agency Representative *

Email (Agency Representative) *

Date Submitted *