Request a Bike

 

Help us get to know you and your family. We would love to hear your story. The more information you provide us, the easier it is for us to process your request for a new bike. We use all the information requested to make a fair and well informed decision. Photos and/or video footage is encouraged (not required) and my be sent to requestabike@denitosrideforkids.com. Our goal is to help as many children as possible so most requests are likely to be approved.  In some cases, medical record verification my be requested. Thanks for your time and interest in DeNito’s Ride for Kids.

Name:*
Address:
E-mail:*
Phone:*
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Annual household income.*
Tell us about your child.*
How would this bike help or affect your child?*
Word Verification: