Booking Form

Rider Details

Name(Required)

First Last

Gender(Required)

Male

Female

Rather not say

DOB(Required)

Age(Required)

Please enter a number from 14 to 99.

Address(Required)

Street Address Address Line 2 City Post Code

Home Phone(Required)

Mobile Phone(Required)

Email(Required)

Enter Email Confirm Email

Cycling club/ group

Emergency Contact Details

Name(Required)

First Last

Relationship to rider(Required)

Home telephone

Work telephone:

Mobile(Required)

Medical and Specific Needs

It is your responsibility (or that of a parent/guardian/carer if under the age of 18) to provide the coach with details of any medical or health conditions, allergies, or dietary or other specific needs that might affect your ability to participate in cycling. Please note that a coach is unable to provide guidance or make decisions relating to medical or health conditions. Rather, if you have any concerns about participating in any form of physical activity, please consult with your GP before signing the consent form.

Please give details of any medical or health conditions, allergies, or dietary or specific needs that might affect your participation in cycling and what support/modifications are needed by the coach.

Please list any medications you take on a regular basis. (This information may be required by the emergency services in the event of an accident)

Arrival and Departure Arrangements if under 18

If under the age of 18, please give details of typical arrival and departure arrangements, eg the names of people you authorise to accompany the rider, and/or whether the rider is allowed to depart alone or with friends.

Rider Information

Previous cycling experience

What do you want to achieve from the sessions?

Please detail any other specific information that is relevant to participation in cycling activity sessions.

Consent for Riders Aged 18 Years and Over

I have read and understood the information on this form and the coach has satisfactorily answered any questions I have asked. I understand and agree that I participate in coached sessions and/or training prescription entirely at my own risk. I have considered the nature of such sessions; I will participate in a safe manner and follow all reasonable instructions from the coach. I confirm that the information I have provided is correct and complete to the best of my knowledge

Parental/Guardian/Carer Consent for Riders Under the Age of 18

I have read and understood the information on this form and the coach has satisfactorily answered any questions I have asked. I understand and agree that my child participates in coached sessions and/or training prescription entirely at their own risk. I confirm that the information I have provided is correct and complete to the best of my knowledge.

Consent for moving from one location to another on the public highway (riders must be aged 12 or older).

Consent for participating in prescribed training (riders must be aged 14 or older).

Consent for appropriate photographs and videos for coaching purposes.

Name(Required)

First Last

Relationship to rider(Required)