Apply for Your Bike

Variety’s “My Bike” Program currently provides Rifton adaptive bikes to children with disabilities who meet the following eligibility criteria:

Location

Reside in one of the 54 counties that Variety currently serves, including: 42 counties in Pennsylvania (Adams, Allegheny, Armstrong, Beaver, Bedford, Blair, Butler, Cambria, Cameron, Centre, Clarion, Clearfield, Clinton, Crawford, Cumberland, Dauphin, Elk, Erie, Fayette, Forest, Franklin, Fulton, Greene, Huntingdon, Indiana, Jefferson, Juniata, Lawrence, McKean, Mercer, Mifflin, Northumberland, Perry, Potter, Somerset, Snyder, Union, Venango, Warren, Washington, Westmoreland, and York), and 12 counties in West Virginia (Barbour, Brooke, Doddridge, Hancock, Harrison, Marion, Marshall, Monongahela, Ohio, Preston, Taylor, and Wetzel).

Diagnosis

Have a diagnosed physical, mental, and/or sensory disability documented by your child’s current physical / occupational therapist, or personal care physician.

Age

Be 4 through 21 years of age. An application may be submitted up to 60 days prior to a child’s 4th birthday.

Application

Current “My Bike” application completed.

Income

Applicant’s household income must meet Variety’s “My Bike” Program income guidelines. Income verification will be required.

# Household Members Household Salary
2 $64,960
3 $81,680
4 $98,400
5 $115,120
6 $131,840
7 $148,560
8 $165,280

*For each additional person, add $16,720.

Letter of Medical Justification (LMJ)

Submit an LMJ from your child’s current physical / occupational therapist or personal care physician indicating that a Rifton adaptive bicycle would be medically appropriate and therapeutic for the child and that a conventional bike would not be appropriate (see pages 12-13 for additional information on letter).

Trial

The successful trial of a Rifton adaptive bike, in which the child is individually fitted / evaluated on a Rifton adaptive bike, and the bike size, color, and adaptations are decided (this is the final step in the application process once everything else is completed – see page 14 in the application for more details).

Presentation Requirement

Variety requires the applicant and his/her parent or legal guardian to attend a scheduled regional presentation to receive the equipment in order to properly review all safety and equipment specifics before it is taken home

My Bike Application My Bike Handout