2017 Bike Helmet Application

Thank you for your interest in submitting an application for bike helmets!

The Ohio AAP is excited to once again provide bike helmets to organizations participating in Bike Helmet Safety Awareness Month – May 2017. Please fill out all sections of the application below as completely as possible, and be sure to click “Submit” when finished. You will see a confirmation message upon successful submission.

The Ohio AAP will provide helmets based upon the available funding, number of applications, and need of each community/organization. Completion of an application is not a guarantee to receive helmets. Notification of bike helmet awards will be made using the email in the application no later than the week of March 20, 2017. If you have any questions about this application or prior to the notification of awards, please contact Hayley Southworth at [email protected].

Applicant Information

Types of events include Bike Rodeos, Helmet Giveaways, etc.
(If Applicable)
(If Applicable)
(If Applicable)

Program Information

XS estimated for ages 3 - 6
S/M estimated for ages 6 - 11
L/XL estimated for ages 11 years and older
(Quantities/Sizes not guaranteed - this field is designed to automatically populate. If it does not populate in your internet browser, simply ignore and we will populate on our end)

Organization Bike Helmet/Injury Prevention Information

Terms of Grant: By typing your initials on each item, and typing your full name at the end of the application, you agree to complete these terms in their entirety in return for receipt of helmets. Failure to complete any of the required items may lead to disqualification for helmets in future years.

Link will be sent to the indicated contact email.
(Inability to pick up helmets during distribution day WILL NOT automatically disqualify applicants from receiving helmets.)