Section 1 of 8
WELLAND VALLEY CC WHIZZ KIDS and UNDER 18 MEMBERSHIP and PARENTAL CONSENT FORM 2026
Welcome to Welland Valley CC!
This form is effective from January 2026 and covers the year to December 31, 2026. This form allows you to consent to the rider taking part in Whizz Kids and other sessions and allows us to hold the correct emergency contact details for you. Please fill in all parts of the form and sign as indicated at the end. If you are under 16 please get a parent, guardian or carer to sign the form on your behalf to provide their consent. We will also use the contact information to keep you up to date with Whizz Kids events and activities and any details used will be for, and by, Welland Valley Cycling Club only.
This form is effective from January 2026 and covers the year to December 31, 2026. This form allows you to consent to the rider taking part in Whizz Kids and other sessions and allows us to hold the correct emergency contact details for you. Please fill in all parts of the form and sign as indicated at the end. If you are under 16 please get a parent, guardian or carer to sign the form on your behalf to provide their consent. We will also use the contact information to keep you up to date with Whizz Kids events and activities and any details used will be for, and by, Welland Valley Cycling Club only.
Rider 1 Name
Rider 1 Name
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Rider 1 Gender (M/F)
Rider 1 Gender (M/F)
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Rider 1 Date of Birth
Rider 1 Date of Birth
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Rider 2 Name
Rider 2 Name
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Rider 2 Gender (M/F)
Rider 2 Gender (M/F)
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Rider 2 Date of Birth
Rider 2 Date of Birth
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Section 2 of 8
Contact Details
Address:
Address:
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Town / City
Town / City
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Postcode:
Postcode:
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Email Address
Email Address
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Section 3 of 8
EMERGENCY CONTACT DETAILS (parent/carer to complete)
Contact 1 Name
Contact 1 Name
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Contact 1 Relationship
Contact 1 Relationship
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Contact 1 Primary Contact Number
Contact 1 Primary Contact Number
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We use WhatsApp to keep in contact for news and updates, please indicate your preference.
We use WhatsApp to keep in contact for news and updates, please indicate your preference.
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Use the Primary Contact Number for Club WhatsApp
Use Alternative Contact number for Club WhatsApp
I do not want to be added to WhatsApp
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Contact 1 Alternative Contact Number
Contact 1 Alternative Contact Number
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Contact 2 Name
Contact 2 Name
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Contact 2 Relationship
Contact 2 Relationship
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Contact 2 Primary Contact Number
Contact 2 Primary Contact Number
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Contact 2 Alternative Contact Number
Contact 2 Alternative Contact Number
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Section 4 of 8
Disability Information
The Disability Discrimination Act 1995 defines a disabled person as anyone with “A physical or mental impairment which has substantial and long term adverse effect on his or her ability to carry out normal day-to-day activities”.
Do you consider yourself disabled? Yes or No?
Do you consider yourself disabled? Yes or No?
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Yes
No
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If Yes please indicate the nature of your disability
If Yes please indicate the nature of your disability
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Visual Impairment
Hearing Impairment
Learning Disability
Multiple Disability
Physical Disability
Other:
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Section 5 of 8
Medical Information
Please detail below any important medical information that our coaches and club should be aware of (for example Asthma, Epilepsy, Diabetes, Recent Injury) If None please enter "none"
Please detail below any important medical information that our coaches and club should be aware of (for example Asthma, Epilepsy, Diabetes, Recent Injury) If None please enter "none"
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Action to be taken in case of Emergency
Action to be taken in case of Emergency
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If you have any concerns about your child participating in any form of physical activity, please consult your GP before giving permission for your child to take part in cycling activity sessions.
If you have any concerns about your child participating in any form of physical activity, please consult your GP before giving permission for your child to take part in cycling activity sessions.
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Have you taken part in much cycling before?
Have you taken part in much cycling before?
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If Yes please indicate where you have taken part in cycling
If Yes please indicate where you have taken part in cycling
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School
Local Authority
Cycling Club
At home or with family
Triathlon Club
British Cycling Event
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Section 6 of 8
Sports Equality Monitoring
Whilst it is not compulsory that this section is completed the following paragraph explains why it is important. Sport can and does play a major role in promoting the inclusion of all groups in society; however, inequalities have historically existed within sport, particularly in relation to Gender, race and disability. British Cycling is committed to promoting and developing sports equality which is about fairness in sport, equality of access, recognising inequalities and taking steps to address them. By monitoring the profile of young people in our clubs we can develop strategies to ensure that all young people have the best opportunity to develop and progress in cycling. To help us monitor our membership can you please tick one of the following boxes to identify your ethnic group?
White
White
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British
Irish
Other:
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BLACK or BLACK BRITISH
BLACK or BLACK BRITISH
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Caribbean
African
Other:
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ASIAN or ASIAN BRITISH
ASIAN or ASIAN BRITISH
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Indian
Pakistani
Bangladeshi
Other:
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MIXED
MIXED
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White and Black Caribbean
White and Black African
Other:
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CHINESE or OTHER ETHNIC GROUP
CHINESE or OTHER ETHNIC GROUP
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Chinese
Other:
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Section 7 of 8
The Small Print
It is part of the British Cycling code of conduct to ensure that reasonable steps are taken to establish a safe environment where young people can enjoy and develop their cycling skills. Parents and carers are welcome to stay and watch the sessions, but this is not compulsory. Young people are expected to remain at the session from signing in to the end of the session unless they have to leave early. If a young person has to leave early or is being collected by someone other than the parent/carer the parent/carer must advise the coach of the arrangement, including who will be collecting the rider.
It is the young person’s responsibility to participate in cycling activities in a sporting manner. Any young rider who persistently misbehaves or puts others in danger will be asked to leave the session.
It is the parent/carer’s responsibility to ensure that their child’s bike is in a safe condition to ride.
A correctly fitting cycling helmet must be worn at all times during the session.
Welland Valley CC may take photographs/video footage during the event. These could be placed on the club website, or for general cycling club publicity purposes. If you do not wish for photographs/video footage of your child to be used please advise us. For children under 12 years of age coaching sessions will take place on a traffic free facility. Over 12’s may be involved in coaching sessions that take place on the highway. Young riders are only invited to take part when the coaches are confident that they are sufficiently responsible for their own actions and have developed the necessary handling skills and fitness levels to cope with riding on the Public Highway.
It is the young person’s responsibility to participate in cycling activities in a sporting manner. Any young rider who persistently misbehaves or puts others in danger will be asked to leave the session.
It is the parent/carer’s responsibility to ensure that their child’s bike is in a safe condition to ride.
A correctly fitting cycling helmet must be worn at all times during the session.
Welland Valley CC may take photographs/video footage during the event. These could be placed on the club website, or for general cycling club publicity purposes. If you do not wish for photographs/video footage of your child to be used please advise us. For children under 12 years of age coaching sessions will take place on a traffic free facility. Over 12’s may be involved in coaching sessions that take place on the highway. Young riders are only invited to take part when the coaches are confident that they are sufficiently responsible for their own actions and have developed the necessary handling skills and fitness levels to cope with riding on the Public Highway.
FOR RIDERS AGED 12+ Only. Please tick here if you DO NOT CONSENT to your rider being involved in activities on the public Highway
FOR RIDERS AGED 12+ Only. Please tick here if you DO NOT CONSENT to your rider being involved in activities on the public Highway
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No I do not want my child being involved in activities on the public Highway
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Section 8 of 8
Parental Consent
I, being the Parent/carer of the rider(s) named above have read the information contained on this form and hereby consent to him/her taking part in cycling activity sessions and understand and agree that he/she participates in cycling activity sessions under the instruction of British Cycling qualified coaches entirely at his/her own risk. I have considered the nature of such sessions and have discussed them with him/her. I am satisfied that he/she is sufficiently responsible and competent to assume full and entire responsibility for his/her safety under the supervision of a British Cycling qualified coach. I confirm that he/she does not have any medical condition or disability not detailed overleaf that could affect her ability to participate safely in cycling activity sessions.
· By completing this form I agree to the child named above taking part in the activities of the club
· I Understand that I will be kept informed of these activities
· I understand that in the event of injury or illness all reasonable steps will be taken to contact me and to deal with the illness or injury appropriately.
· I have read the Parents Code of Conduct document outlining my responsibilities.
· By completing this form I agree to the child named above taking part in the activities of the club
· I Understand that I will be kept informed of these activities
· I understand that in the event of injury or illness all reasonable steps will be taken to contact me and to deal with the illness or injury appropriately.
· I have read the Parents Code of Conduct document outlining my responsibilities.
Name
Name
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Signature
Signature
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Today's date
Today's date
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