Parental Consent Form

Parental Consent Form
Young people are welcome to take part in Verulam Cycling Club’s activities and from time to time we run specific events for children and young people. However we require that parents or guardians of young people taking part in all our activities to complete our parental consent form and pay our Youth Annual Membership of £5.

Information for Parents
Purpose: This form should be completed by the parent/guardian of anyone under 18 years of age wishing to join the Club and take part in Verulam Club and/or Verulam reallymoving.com Racing Team activities.

Completed forms should be submitted online where they will be processed by our Membership Secretary and reviewed by our Youth Development Secretary.

A Cycling Time Trials Consent Form (available on request) is also required if you wish to participate in Club and Open Time Trials. On Sunday club runs, youths must be accompanied by an adult (who may be a Club Runs Leader).

Some of Verulam Cycling Club activities can be challenging and anyone taking part, including youths, must have the minimum level of skills and a suitable bicycle to participate in that activity. We also require that youths taking part in our activities wear suitable clothing and must wear a good fitting cycling helmet.

PARENT / GUARDIAN INFORMATION

Parent / Guardian name *

Parent / Guardian email address *

Relationship to young rider *

YOUNG PERSON'S DETAILS

Forename *

Surname *

Year of birth *

Address *

Post Code *

Medical/Health Conditions *

Please give details of any medical or health conditions, allergies, or dietary or specific needs that might affect the participation of the youth in cycling and what support/modifications are needed by the coach

Medications *

Please list any medications taken by the youth on a regular basis. (This information may be required by the emergency services in the event of an accident).

Collection and Drop-off arrangements *

Please give details of typical arrival and departure arrangements, e.g. the names of people you authorise to accompany the youth rider, and/or whether the youth rider is allowed to depart alone or with friends.

Types of Consent

I consent for participation by the youth in coaching activities in a traffic-free environment. *

Yes

No

I consent for participation by the youth in moving from one location to another on the public highway (riders must be aged 12 or older). *

Yes

No

I consent for participation by the youth in prescribed training (riders must be aged 14 or older). *

Yes

No

I consent for the use of photographs or videos of the youth participating in our riding activities for publicity or coaching purposes e.g. website, social media. We adhere to the BC Safeguarding Policy: *

Yes

No

BC Safeguarding Policy

I have read, understand and I, and therefore the youth applicant, agree to abide by the following: *

Yes

All types of cycling are activities with a risk of accidents and a danger of personal injury. As a Parent/Guardian of a participant in these activities I recognise, understand and accept these risks and will be responsible for my child/ward’s actions.

I have read and understood the information on this form and the Youth Development Secretary has satisfactorily answered any questions I have asked.

I understand and agree that my child participates in the activity entirely at their own risk. I confirm that the information I have provided is correct and complete to the best of my knowledge.

Signature *

PRINT NAME *

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