Online Application

Application for an Adaptive Bike

The Two Angels Foundation focuses on helping children (18 years old and younger) living in Colorado with physical disabilities live the most active and normal lives possible by providing them with adaptive bikes.

Application Instructions

This form is intended to let the Two Angels Foundation learn more about the potential recipient of the adaptive equipment requested. Please answer all of the questions thoroughly to provide us with the most information possible. Applicants must live in Colorado and be 18 years old or younger. Please complete this application in its entirety. In addition to this form, all applications need to include the following:

  • A letter of justification from a physical therapist or occupational therapist stating the need and intended use for the requested adaptive bike.

For assistance completing this application, please contact Dawn Mohatt at dawn@twoangelsfoundation.org or 720-940-6078.

Priority is given to applicants who have never before received a gift from Two Angels Foundation.

Applications are accepted at any time throughout the year, however, decisions are made in the months of February, May, August and December. Two Angels Foundation will acknowledge receipt of all applications, typically within ten days. Please note that each year we receive many more applications than we are able fund.

**Please note that Numotion is our preferred vendor and all approved applicants will need to order any approved bikes through them. Grants for bikes are usually between $1,000 -$1,500.

Medical Information

A letter of justification from a physical therapist or occupational therapist stating the need and intended use for the requested adaptive bike is required to process the application.

Adaptive Recreational Equipment Requested

Two Angels Foundation uses Numotion as our preferred provider and asks all approved applicants to go through Numotion to be evaluated for the requested equipment.

A letter of justification from a physical therapist or occupational therapist stating the need and intended use for the requested adaptive bike.

We do ask that all families consider a donation to support the program, which is supported solely by donated funds. Families often ask how much of a donation is reasonable. We suggest a donation of $100 or ANY amount that you and your family feels is available for you at this time. If this option is available to you, you can support Two Angels Foundation with a donation by check or online at www.twoangelsfoundation.org.

Terms and Conditions Agreement Form

By my signature below, I (recipient parent or legal guardian) acknowledge that I understand and agree to the following:

  1. That Two Angels Foundation, Inc. is not obligated to provide any or all of the equipment that have been requested.
  2. The Two Angels Foundation, Inc. is neither responsible nor liable for fitting the requested equipment.
  3. That some of the pieces of equipment provided may have been used and reconditioned.
  4. That the Two Angels Foundation, Inc. has permission to contact the physicians and/or therapists listed in the medical information section of this application to inquire about the applicant’s ability to use the requested bike.
  5. That when the bike is delivered to the Recipient it becomes the sole responsibility of the Recipient. That includes all maintenance, replacements and repairs.
  6. That when the equipment is delivered to the Recipient or at a Two Angels Foundation event any photos taken of the Recipient using the bike may subsequently be used for publicity and promotional purposes including the child’s first name.
  7. That upon receipt of a bike, I will inspect the equipment and notify the Two Angels Foundation, Inc. of any problems or damages that may have occurred before the bike was delivered to me.
  8. That I will release and discharge the Two Angels Foundation, Inc. its agents, officers, employees, affiliates, and all other persons, firms, associations and corporations of and from any and all actions, claims and demands which Recipient may now have, or may later have on account of injuries to Recipient or damages to any property arising out of an accident, casualty or occurrence which may happen through the use of the bike provided by the Two Angels Foundation, Inc.
  9. The personal and medical information that I have voluntarily provided to the Two Angels Foundation, Inc. may be used or shared for the sole purpose of acquiring the equipment requested.
  10. I have read, understood and agreed with each of the terms as stated above.