IBMXC COACHING CONSENT FORM 2024
This form should be completed by all riders, participating in coached sessions or prescribed training from a British cycling qualified coach. You should read the appendix carefully before providing consent.
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Email *
Rider details
Full name *
Gender *
Required
Date of birth *
MM
/
DD
/
YYYY
Address *
Contact number *
Emergency contact details
Full name *
Relationship to rider *
Phone number *
Medical and specific needs
It is your responsibility(or  that of a parent/guardian/carer under the age of, 18) to provide Ipswich BMX club with details of any medical or health conditions allergies, or dietary or other specific needs, that might affect your ability to participate in cycling. Please note that the coach is unable to provide guidance or make decisions relating to medical or health conditions. Rather if you have any concerns about participating in any form of physical activity, please consult with your GP before signing the consent form.
Please list any medications you take on a regular basis. This information may be required by the emergency services in the event of an accident. *
Please give details of any medical or health, conditions, allergies, or dietary or specific needs that might affect your participation in cycling and what support/modifications are needed by the coach? *
Arrival and departure information
Whilst riders, under the age of 18 may travel to, and from sessions, unsupervised, or maybe accompanied by a responsible person who is not the riders parent/guardian/carer. The coach has a responsibility to ensure that all riders leave the session safely.
If under the age of 18, please give details of typical arrival and departure arrangements, e.g. the names of people you authorise to accompany the rider and/or whether the rider is allowed to depart alone, or with friends *
Rider information
Riders previous cycle experience *
What do you want to achieve from the sessions? *
Please detail any other specific information that is relevant to the participation in cycling activity sessions *
Consent for riders, aged 18 years and over
I have read and understood the information on this form and the coach has satisfactorily answered any questions I have asked and I understand and agree that I participate in coach sessions and/or training described  entirely at my own risk. I have considered the nature of such sessions. I will participate in a safe manner and follow all reasonable instructions from the coach. I confirm that the information I have provided is correct and complete to the best of my knowledge. *
Consent for riders aged under 18 years
I have read and understood the information on this form, and the coach has satisfactorily answered any questions. I have asked. I understand and agree that my child participates in coached sessions and/or training described entirely at their own risk. I confirm that the information I have provided is correct and complete to the best of my knowledge. *
Name *
Relationship to the rider *
Coach contact
If you require any further information or would like to discuss the form, please speak to one of the Ipswich BMX club coaches at the track or contact the club directly via the website. Contact us page or email Ipswichbmx@gmail.com 
The club coaches are are are as follows
Mark Steele
John Lillingstone
Shaun Andrews
Lewis, Allison
Abi Pike
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