Apply for a Bike

Applications for CFC bikes or trikes for children and teenagers  can be made by any British citizen, resident in the UK (applications from non British citizens will be considered where UK residency can be proven).  Simply fill out the form below and we will process your application as quickly as possible.  If you have any difficulties viewing the links or filling in the on line form please call us free on 0300 500 4040 and we can take your application over the telephone. Office hours 9.30am to 3.30pm Monday to Friday. The young person benefiting from the grant must be aged 18 or under at the time of application.

Before you fill in the form, please make sure you have read our FAQ’s page which gives lots of useful information on things like, the type of bike you may apply for and other matters regarding application and delivery.  To view the range of standard bikes we offer please visit www.dawescycles.com or www.trekbikes.com ;trikes are supplied by a range of specialist motability companies, depending on specific requirements.

If you still have any questions, please feel free to contact us and we’ll answer your enquiry as soon as we can.

You may also apply for an award through your consultant, physiotherapist, specialist nurses, doctors, other health professionals and Teenage Cancer Trust, Clic Sargent, other social/support workers .

Please note, if you need a specially adapted bike or have a non-standard request, the best thing is to contact us directly.

We prefer electronic applications, but if you need a paper version of this form you can request one by emailing info@cyclistsfc.org.uk.

Application Form

Applicant's Details:

Name *

Email address*

Telephone Number*

Address

Street Address *

Address Line 2:

City/Town

County*

Post Code*

Country*

Beneficiary's Details:

Name *

Date of Birth*

Email address*

Telephone Number*

Address

Street Address *

Address Line 2:

City/Town

County*

Post Code*

Country*

Additional Information

Height feet inches

Inside leg* to floor measurement (in inches)

Consultant's Name

Consultant's Number

Hospital

How did you hear about CFC? CFC rep Clic Sargent Hospital Word of mouth Advertising (e.g poster or leaflet etc) Social media/CFC website Event Other charity Other (please state) 

Other (if required)

Case History

Short Case History*

Further Details (if required)

Details of bike required* Please indicate use, terrain etc

For validation purposes please complete the question below:

3+7=