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2. Dan Lechner Farmers Insurance Agency has approximately 20 bikes to give away to Liberty Community Christmas Tree families this year. Please fill out the form below. It will help determine if Dan and his team have a bike that would fit your child's needs.  

   The number of bikes available is limited. We have identified recipients who have listed a bike on their LCCT application and need to collect some additional information through this form. Please do not share this form link with anyone else.

4. Your Name:
6. Address:
8. Phone Number:
9. Email Address:
13. Child Name:
15. Child Gender:
16. Child Age:
18. Child Height:
19. Child Weight:
21. Training Wheels Needed?
    -- Select One --YesNo
22. If there is a bike available, are you able to pick it up in Kearney, MO?
    -- Select One --YesNoMaybe
23. If there is a bike available, are you able to pick it up from the Liberty Community Center (1600 S. Withers Rd, Liberty, MO 64068)?
    -- Select One --YesNoMaybe
Leave This Blank:


25. 1. Receive an email copy of this form.
26. Email address

    This field is not part of the form submission.

27. Submit

* indicates a required field