Adult Membership form -

Members Details

Please enter your details

Name:

First

Last

Date of Birth:

Gender:

Male
Female

Address:

Postcode:

Phone No

If you no longer have a landline please complete with you modile No

Mobile No

Email

British Cycling Membership:

Emergency contact details

Person we should contact incase of emergency

Name

First

Last

good my No

Address

Postcode

Phone No

If you no longer have a landline please complete with you modile No

Mobile No

Email

Relationship to member

Medical information and Conent

In this section you will be asked to provide medical information and asked to consent to allow medical treatment

Please give details of any medical/health conditions both physical and mental that might affect your participation in club activities:

If the person appling for mebership dosen’t have any medical condiditions please complete with “NONE”

Please give details of any specific needs you have which may affect their participation:

If the person appling for mebership dosen’t have any Specific needs please complete with “NONE”

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

If the person appling for mebership dosen’t take reular medication complete with “NONE” Please ensure that you bring adequate supplies of medication and dosage for the duration of the activity

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

If the person appling for mebership dosen’t have any Allergies please complete with “NONE”

MEDICAL CONSENT- In the case of an emergancy. I consent to being given any medical, surgical or dentail treatment, including general anaesthetic and blood transfusion, as considered necessary by the medical authorities present

Yes
No

Disclaimers

Team Darenth’ s Liability Waiver & Participation Agreement

Please read Team Darenth’ s Liability Waiver & Participation Agreement and agree with it to complete your Team Darenth membership.

Name

1. Assumption of Risk

I understand that cycling activities, including training sessions, group rides, off-road riding, races, and skills coaching, involve inherent risks. These may include falls, collisions, mechanical failures, weather conditions, uneven terrain, and other hazards that can result in injury.
I voluntarily choose to allow my child to participate in these activities and accept all associated risks.

2. Responsibility for Personal Safety

I agree that it is my responsibility to ensure that my child
• Rides safely and follows the instructions of coaches, ride leaders, and club volunteers.
• Uses a roadworthy and safe bicycle and wears appropriate safety equipment, including a properly fitted helmet.
• Inform the club of any medical conditions that may affect participation.
• Follow the Highway Code and all relevant laws when riding on public roads.

3. Waiver of Liability

I understand that the club, its coaches, volunteers, committee members, and ride leaders cannot eliminate all risks associated with cycling.
To the fullest extent permitted by law, I agree that Team Darenth Cycling Club, its officers, coaches, volunteers, and members are not liable for any injury, loss, or damage arising from participation in club activities, except where caused by negligence that cannot legally be excluded.

4. Medical Treatment Consent

In the event of an accident or injury, I consent to first-aid being administered and, if necessary, emergency medical treatment. I understand that I am responsible for any resulting medical costs.

5. Insurance

I understand that club activities may be covered by British Cycling insurance only when led by appropriately qualified coaches or Ride Leaders. I accept that some activities may not be covered and participate at my own risk.

6. Agreement

By ticking yes, I confirm that I have read and understood this waiver, and that I accept the terms of participation.

I agree

Yes
No