Pedal Ahead Sign Up – Pedal Ahead

* SD School District Employees, Teachers and Staff applications are ONLY accepted at www.pedalaheadsdschools.com

Electric bicycle quantity is limited and based on availability, program bikes are awarded prioritizing income threshold and application date. ALL application fields must be completed for consideration.*

Yes

I acknowledge failure to sustain mileage requires returning the bicycle for re-allocation

Yes

Name*

First Last

Occupation*

Name of Employer (Business)

Position at Work*

Date of Birth*

Email*

Street Address*

Phone*

Zip Code*

Personal Reference:*

Reference Phone*

Reference Email*

How frequent will you use the e-bike?*

Everyday
Connect to public transportation
Commute to work
Day to Day activities
Recreation/Exercise

What is the distance between work and home ?*

1-3 Miles
4-6 Miles
7-10 Miles
More then 10 Miles
I am familiar with a bike route to commute

What is your energy levels during the day*

High
Average
Low
Varies

How many hours per week do you exercise?*

0-1 hours
2-3 hours
4-6 hours
6+ hours

Would you be willing to commit to an hour of exercise per day, 3 days a week?*

Yes
No

How much time do you spend sitting in a day*

1-3 hours
4-6 hours
7+ hours

Do you have any pre-existing health conditions*

Yes
No

How would you describe your quality of sleep*

Deep Restful
Average
Low Quality
Varies

Number of family members in household:

Note: One Pedal Ahead e-bike allowed per household

Number of Cars in household

Note: One Pedal Ahead e-bike allowed per household

What is your bicycle riding experience?

What benefits do you expect to get from using an electric bicycle?

Are you currently in recreational activities, sports, yoga, etc...Please List

Please list your height

Are you willing to:

Participate in monthly meetings at our headquarters or other locations (TBD) for training, meetings and group rides.
Be trained on technical skills – bicycle maintenance
Be trained on business operations
Do small group ride on a regular basis (once a month)
Commit to a 2 year agreement, and share trip data with Pedal Ahead. RSV does not release respondents' information.
PROGRAM REQUIREMENT: Secure low cost bicycle insurance that covers liability, loss, theft and damage to the Pedal Ahead e-bike.
Sign up for the Pedal Ahead monthly newsletter spotlighting program news, information, events and rides; and tips on e-bike operation and maintenance.

What would you use an electric bicycle for, check all that apply:

Annual income:*

(Which of these describes your personal income last year?)

Driver’s License number:

What Percentage of Your Trips are By Car?

What Percentage of Your Trips are by Standard Bicycle?

What Percentage of Your Trips are By Public Transportation?

What Percentage of Your Trips are Walking?

Are you a member of a community organization

Yes
No

Organization name

Any additional feedback?

Where did you hear about the program:

I agree to mileage requirements of averaging 5 miles/day, 35 miles/wk or 140 a month*

Yes

I acknowledge failure to sustain mileage requires returning the bicycle for re-allocation

Yes

I agree to sign a liability waiver for any party to indemnify, defend and hold the other party(s) harmless from any claims or damages to anyone with responsibilities under the program; and from any negligence, errors or omissions by any directors, officers, employees, subcontractors or agents of the Indemnifying Party.

Yes

* SD School District Employees, Teachers and Staff applications are ONLY accepted at www.pedalaheadsdschools.com

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