Abergavenny RC (youth) rider consent form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Email *

Rider's Surname *

Rider's First name *

Is the rider under 18?

Yes

Clear selection

Gender *

Female

Male

Telephone number

British cycling membership number

Please give details of any medical or health conditions that might affect your participation in cycling and what support/modifications are needed *

Please list any medications you take on a regular basis *

Please give details of any specific needs of which the coach should be aware, and what support/modifications are required: *

Previous cycling experience

What other sports do you participate in regularly? How often?

Why are you attending the sessions?

What do you want to achieve from the sessions?

In the long term, what do you want to achieve from your participation in cycling?

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

Consent for participation in coaching sessions

Consent for Participating in Coaching Sessions

I, being the rider listed above or the legal parent/guardian of the rider listed above if they are under 18, have read the information on this form and the following notes, and consent to taking part in the coaching sessions conducted in a traffic-free environment. I understand and agree that participation in coaching sessions under the instruction of British Cycling coaches is entirely at my own or their own risk. For riders under 18, I have considered the nature of such sessions and have discussed them with the rider listed above. I am satisfied that they are sufficiently responsible and competent to assume full and entire responsibility for their own safety.

Notes for riders under 18:
• You are giving consent for the rider listed above to participate in coaching sessions conducted in a traffic-free environment.
• It is part of the British Cycling Code of Conduct to ensure that reasonable steps are taken to establish a safe environment where young riders can enjoy developing their cycling skills. Parents/guardians are encouraged to stay and watch the session.
• Young riders are expected to remain in the session from beginning to end, unless they have to leave early. If the rider has to leave early, or is being collected by someone other than the parent/guardian, the parent/guardian must advise the coach of the details of the arrangement, including who will be collecting the rider.
• Young riders who persistently misbehave or put others in danger will be asked to leave the sessions and will not be allowed to attend in future.
• It is the parent’s/guardian’s responsibility to ensure that their child’s bike is in a safe condition to ride.

All riders must ensure:
• They wear a cycling helmet at all times during the coaching sessions.
• They wear suitable clothing to coaching sessions.
• Thy take a drink to coaching sessions.

Please ensure you make a note of any medical conditions your child has or you feel the coach should know about (in Section 3). 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 the coaching sessions.

I have read and agree to the conditions given above *

Yes

I am aware that photographs and video footage may be taken during sessions and events for coaching and promotional purposes. I consent for myself or the rider listed above to appear in photographs. I understand that no personal information will be displayed with the image. *

Yes

Name of person completing form *

Send me a copy of my responses.

Submit

Clear form

Never submit passwords through Google Forms.

reCAPTCHA

Privacy Terms

This form was created inside of The Corken Family Mail.

Does this form look suspicious? Report

Forms