Address, including Postcode

Email Address

Mobile/Tel

Emergency Contact Name

Emergency Contact Number

Medical Conditions (if applicable)

Please provide your British Cycling membership number e.g. 1457480 (if applicable)

Please note, all entry fees and jersey fees must be paid via BACS prior to the event. Please pay via BACS to:

HELPING HAND

Account No.: 10311971

Sort Code: 01-05-14

Please include 'LL2023 and your surname, plus the first letter of your first name' as your reference e.g. 'LL2023 DerbyshireS'

By entering, I agree to the following declaration:

I agree to abide by the British Cycling Regulations for non-competitive cycling events, and understand and agree that I participate in this event entirely at my own risk, that I must rely on my own ability in dealing with all hazards, and that I must ride in a manner which is safe to myself and others. I am aware that when riding on a public highway the function of marshals is only to indicate direction and that I must decide whether the movement is safe. I agree that no liability whatsoever shall attach to the promoter, promoting club/organisation, event sponsor, British Cycling or any event official or member of British Cycling or member of the promoting club/organisation in respect of any injury, loss or damage suffered by me in or by reason of the event however caused. I will participate in cycling events in a loyal and sporting manner. I will submit to disciplinary measures taken against me and will take any appeals and litigation to the authorities provided for in the Regulations. Subject to that reservation, I shall submit to any dispute that may arise exclusively to the courts. I have read and agree to abide by this declaration.

Parent or Guardian Full Name

Parent or Guardian Address, including Postcode

By entering, I agree to the following parent/guardian declaration:

Being the parent or guardian of the above rider I:

Understand and agree that my son/daughter participates in events promoted under the British Cycling Guidelines for non-competitive cycling events entirely at his/her own risk. I have considered and understand the nature of such events and have discussed them with my son/daughter. I am satisfied that my son/daughter is sufficiently responsible and competent to assume full and entire responsibility for his/her own safety whilst engaged in non-competitive events organised under British Cycling Regulations. I understand that riders over 16 years of age are permitted to participate on the public highway and must therefore assume full and entire responsibility for their own safety in relation to other traffic. I understand and have emphasised to my son/daughter that the function of marshals in such events is to do no more than indicate the direction the rider should take and that the responsibility for safety whilst negotiating corners, turns and other hazards must rest with the rider alone. understand further and have impressed upon my son/daughter that all participants in events on the open road must observe the law of the land relating to road travel. agree that my son/daughter shall participate in such events without any liability whatsoever on the part of the promoter, promoting club, British Cycling, or any club or organisation affiliated thereto or their officials or members in respect of any injury, loss or damage suffered by him/her, provided that this does not exclude the liability of any such party for death or personal injury arising from that party's negligence. I confirm that my son/daughter does not have any disability or medical condition, physical or mental, which could affect his/her ability to ride safely in the event entered. I understand that I must notify the Chief Executive of British Cycling at once if at any time my son/daughter becomes subject to a disability or medical condition, physical or mental, which could affect his/her ability to ride safely in the event entered.