Waiver - Guided Rides

Please fill out the following form.

First name

Last name

Address

Email

Phone Number

Date of birth

Day

Month

Year

Previous Mountain Bike Experience

Have you participated in guided mountain bike rides before?

Yes

No

Do you ever cycle on the road?

Yes

No

If you answered Yes - How often?

Have you ever undertaken any cycle training or received any cycling coaching?

Yes

No

Emergency Contact Details

First Name

Last Name

Relationship to Rider

Telephone Number

Medical Information

If yes to any of the above, please provide details:

Do you consider yourself to have a disability?

Yes

No

Prefer not to say

If yes, what is the nature of your disability and any particular support you require?

Do you suffer from any other condition requiring medical treatment or medication?

Yes

No

If yes, please provide details:

Are you allergic or sensitive to any medication (eg penicillin), insect bites or food?

Yes

No

If yes, please provide details:

Have you been immunised against the following diseases?

Poliomyelitis

Tetanus (lock jaw)

Not Appicable

If yes, please provide details:

Are you taking any form of medication on a regular basis?

Yes

No

If yes, please provide details:

Please ensure that you bring adequate supplies of medication and dosage for the duration of the activity.

Please supply any additional information that the mountain bike leader should be aware of (eg recent illness, medical information special requirements etc) which may affect the full range of activities in this ride, and what support/modifications are needed:

Additional Info on MTB leader needs to know

DECLARATION In the case of the applicant being over 18 years of age, the following must be read and signed: I declare that the above information is correct and that the person in charge has my permission to authorise medical treatment in an emergency.

Signature field is empty.

Date

Day

Month

Year

Insurance Cover

The ride is insured in respect of legal liabilities (third party liability). However, participants have no personal accident cover unless they have been specifically advised of this in writing by the organiser of the ride. It is the participants’ responsibility to arrange for any extension of insurance cover unless advised differently by the leader or the organiser of the ride.

Check this box to accept you have read our Terms and Conditions

Waiver - Guided Rides

Emergency Contact Details

Medical Information

Insurance Cover

Our Commitment

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