EX BB6

EXPLOREREX BB6 EX BB8

Rider Age (Years) 6–12 6–12Rider Inseam 16”–26” 16”–26”Max. Load (lbs) 125 225Bike Weight (lbs) 48 63Wheel Size 6” wide 8.5” wide Frame Height 23” 29”(without Seat)

Total Length 46”* 61”(*with Heavy Duty Assistance Handle add 6”)

Bike Width 12” 17”

2018 Evaluation Form

Explorer SeriesBalance BikeEX BB6” and EX BB8”AGE: 6–12 YearsINSEAM: 16"–26"

Made for those active riders, the Explorer Series gets back to Freedom Concepts’ roots with a focus on the rider who just needs a little something extra to help them move along.

The Balance Bike is designed as a true therapy tool for use in a clinical setting. The device can be used to transition the rider from a bicycle with training wheels to one without.

1 .800.661.9915 www.freedomconcepts.com

S t a n d a r d F e a t u r e sHigh Rise Handlebars with InfiniteSteeringAdjustment

Heavy Duty Steel Chain GuardMountain Style Pedals

O p t i o n s Footplates

Heavy Duty Assistance Handle (A)Seat Back Support (B)

(A)

(B)

BB6/BB8AGE: 6-12 YEARS INSEAM: 16"–26"

EX BB FRAME CHOICE

E. Total Length: BB6 - 46” / BB8 - 61” F. Width: BB6 - 12” / BB8 - 17”

PEDAL POWER

Easy

Average (std)Challenging

E F

BOTTOM BRACKET POSITION Standard (6.5") OR Custom

_______________inches _______________cm

L. Position of bottom bracket in relation to the seat post.

Bottom Bracket (see inseam) Up Down (std)

RIDER INFORMATION

Rider’s Name: ____________________________________________________

Date of Birth: MONTH ____________ /DAY ____________ /YEAR ___________

Therapist’s Diagnosis: ______________________________________________

Weight: _______lbs. _______kgs. Height: _______inches _______cm

A. Seat Depth: ________________ inches ___________ cm

B. Inseam: __________________ inches

_____________________ cm

C. Back Height: _______________ inches

__________________ cm

D. Seat Width: _______________ inches ___________ cm

THERAPIST’S Name: ______________________________________________

Phone: ___________________________________________________________

Fax: ____________________________________________________________

Email: ___________________________________________________________

A

C D

B

PROPULSION

Direct Drive (std)

Free Wheel

EX BB6

EX BB 6 Special Edition (Special Edition includes: HD Assistance Handle & Seat Back Support)

EX BB 8

Heavy Duty Assistance Handle

Custom Frame call for price

TOTAL

BOTTOM BRACKET WIDTH

K. Standard Crank 6" Wide (std)

Custom Crank

K

PAGE SUB-TOTAL

COMMENTS

Balance Bike Evaluation Form (Jan 31/18) 1.800.661.9915 fax 204.654.1149 Effective January 31, 2018 Page 1

COLOR CHOICE

Candy Blue Hot Rod Purple (std)

Blue Red Yellow Pink

Other Custom Color

Please Specify: ____________________

Sticker Type Male Female

Please note extra delivery time for non-standard & custom colors.

W E C A N C U S T O M B U I L D B A S E D O N Y O U R S P E C I F I C N E E D S !

L

Shorter range is suitable for limited knee flexion.

G. 3" (79mm) x 26T Alloy Crank (n/c)

H. 4" (102mm) x 32T Alloy Crank (std)

i. 5” (127mm) x 32T Alloy Crank (n/c)

J. Crank Shortener (reduces length by 1/2”)

CRANK ARM LENGTHS - RANGE OF MOTION

G H I J

FORK

Tubular Steel Fork (std)

TIRES

6” Wide - All Terrain Tires (BB6 only) (std) 8.5” Wide - All Terrain Tires (BB8 only) (std)

HANDLE BAR BASE HEIGHT (*) 12” Height (n/c)

6.5” Height 9.5” Height

CHAIN GUARD

Heavy Duty Steel Chain Guard (std)

BRAKE LEVER POSITION

Back Brake (std)Front Brake

LEVER POSITIONING Rear Brake Front Brake

Left Handlebar

Right Handlebar

Rear Assistance Handle

PAGE SUB-TOTAL

Creating a CYCLE of mobilityTM 1.800.661.9915 www.freedomconcepts.com Effective January 31, 2018 Page 2

SEAT BASE

8. Back Support9. Bicycle Saddle-Style Seat (std)Chest Strap (Back Support Only) (std)

9

COMMENTS

W E C A N C U S T O M B U I L D B A S E D O N Y O U R S P E C I F I C N E E D S !

8

HANDLE BARS Steering Locked Steering Unlocked

M. Wide (std)

N. Hoop

O. Small Hoop

P. High Rise

i. Bar End Extensions

ii. Nameplate Special Dedication Company Logo

16"

i

iiM

O

N

P

18"

PEDALSMeasure Rider’s Shoe: i) _____ inches _____ cm ii) ______ inches ______ cm OR TRACE OUTLINE OF RIDER’S SHOE ON A PIECE OF PAPER & SUBMIT w/ORDER.

1. Mountain Style Pedal (std) 2. with Cage 3. Neoprene Adjustable Footplate* S M L XL 4. Molded ABS Footplate System* XS S M L XL (5. Molded ABS Footplates with Ratcheting Straps

Size Options: XS S M L XL 6. Pulley System (FRONT: corrects plantar flexion)Pulley System (REAR: self-leveling pedals) 7. Abductor Leg Brace *requires #5 Molded ABS Footplate S M L

Please specify Left or Right 0.25” Footplate Spacers Qty: ______/Pedal

5 76

3 42

ii

i

Shoe Heel Widest Point

Shoe length

1

Creating a CYCLE of mobilityTM 1.800.661.9915 www.freedomconcepts.com January 31, 2018 Page 3

PRIVACY POLICYFreedom Concepts Inc. collects, uses and discloses personal information of the Customer and/or Rider to properly assemble and manufacture the mobility deviceand may contact the Rider’s therapist for additional personal information to assistwith this process. The collection, use and disclosure of the personal informationof the Customer and/or the Rider is governed by any consent which may, from timeto time, be provided, and by the Freedom Concepts Inc. Privacy Policy which isavailable on our website www.freedomconcepts.com or by contacting our office.By signing below, you hereby warrant that you have the authority to bind the Riderand hereby authorize the collection, use, and disclosure of personal information asherein provided and in accordance with the Freedom Concepts Inc. Privacy Policy.

TERMS & CONDITIONSPrices are subject to change without notice. Prepaid or net 30 days O.A.C.All taxes extra. Freight extra. Manufacturer reserves the right to change prices,colors, features, dates, locations and products without notice. Residentialdelivery charge may apply. Duty and brokerage included where applicable.

SIGNATURE OF PARENT

I hereby give permission to Freedom Concepts Inc. to use photographs of me or my child for the sole purpose of the company’s promotional use, and will not be distributed to third parties.

YES NO

CUSTOMER SIGNATURE

CUSTOMER INFORMATIONDealer/Vendor: ______________________________________________________

Contact Person: _____________________________________________________

Address: ___________________________________________________________

City: ________________________ Prov./State: ___________________________

Postal/Zip Code: _____________ Ordered by: ___________________________

Phone: ____________________________ Fax: ___________________________

Email: _____________________________________________________________

ORDER INFORMATIONPurchase Order: _____________________________________________________

Order Date: __________________________________ Quote Date: ____________

FCI Representative: __________________________________________________

Payment Terms: _____________________________________________________

CREDIT CARD (check one) Visa MasterCard Exp. Date: ___________

Card Number: _______________________________________ __________

Name On Card: _________________________________________________

Signature: ______________________________________________________

SHIPPING INSTRUCTIONS

Name: _____________________________________________________________

Address: ___________________________________________________________

City: _______________________________________________________________

Province/State: ______________________________________________________

Postal/Zip Code: ________________ Phone: ______________________________

Federal ID/SS#: ______________________________________________________Total - Page 3

Total - Page 2

Total - Page 1

SUB-TOTAL

Boxed (Some assembly required)

Freight (crated)

Residential Delivery

Tax 1

Tax 2

Other

TOTAL

ABDUCTOR/ADDUCTION10. Abductor (Removable Leg Divider)

11. Padded Leg Adduction Strap M L

10 11

GLOVES

Hand Tracing RequiredB

A

X Small Small Medium Large

Custom

A. Measure width of palm_____ inches _____ cm

B. Measure width of wrist_____ inches _____ cm

C. Measure bend of wristto top of middle finger

C

ACCESSORIES

Self Centering Spring Locking Hand Brake (std) Safety Flag Wheel Reflectors (std)

Animal Squeaky Horn (n/c)Multitool (sold seperately) (std)Bell (std)Tool Pouch Bike Covers Cane/Crutch Holder Oxygen Tank Holder (Specify Tank Size ________) iPad/Tablet Holder Communication Tray Simulated Sheepskin Seat Cover Child Adult