Consent Form

Name(Required)

First Last

Year of Birth(Required)

Postcode(Required)

Ethnicity

Please select one

Gender

Impairment/long term health condition

Please select one

Other health condition

Email address(Required)

Name of emergency contact(Required)

First Last

Phone number for emergency contact(Required)

By submitting this form you are agreeing to the following:

We (the participant, parent and/or the carer) understand and are happy that the sessions will be led by experienced cycle trainers.
We are aware that they will offer us guidance, advice, and support regarding cycling and cycling related matters.
We agree that there is an element of risk in all activities, but we are happy to proceed with the session.
We understand that the carer or parent is responsible for the care and supervision of the participant.
Cycle helmets are available which we may choose to use or not use and that we participate at our own risk.
Should anyone’s behaviour be endangering the safety of themselves or others, they will be asked to leave.