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WELLAND VALLEY CC WHIZZ KIDS and UNDER 18 MEMBERSHIP and PARENTAL CONSENT FORM 2026
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Rider 1 Name
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Rider 1 Gender (M/F)
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Rider 1 Date of Birth
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Rider 2 Name
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Rider 2 Gender (M/F)
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Rider 2 Date of Birth
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Contact Details
Address:
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Town / City
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Postcode:
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Email Address
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EMERGENCY CONTACT DETAILS (parent/carer to complete)
Contact 1 Name
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Contact 1 Relationship
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Contact 1 Primary Contact Number
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We use WhatsApp to keep in contact for news and updates, please indicate your preference.
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Contact 1 Alternative Contact Number
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Contact 2 Name
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Contact 2 Relationship
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Contact 2 Primary Contact Number
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Contact 2 Alternative Contact Number
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Disability Information
Do you consider yourself disabled? Yes or No?
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If Yes please indicate the nature of your disability
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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"
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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.
Have you taken part in much cycling before?
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If Yes please indicate where you have taken part in cycling
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Sports Equality Monitoring
White
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BLACK or BLACK BRITISH
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ASIAN or ASIAN BRITISH
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MIXED
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CHINESE or OTHER ETHNIC GROUP
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The Small Print
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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Parental Consent
Name
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Signature
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Today's date
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