Join Us – Team Darenth Cycling Club

Members – Name:

First

Last

Members – Date of Birth:

Gender:

Male
Female

Members – Address:

Members – Post Code:

are affect and

Members – Phone

(If member aged under 18 years Parent or guardian)

Members – Mobile

(If member aged under 18 years Parent or guardian)

Members – Email

(If member aged under 18 years parrent or guardian)

Members – British Cycling Membership:

Emergency Contact – Name

First

Last

Emergency Contact – Address

Emergency Contact – Postcode

Emergency Contact – Phone

Emergency Contact – Email

Emergency Contact – Relatoinship to Member

Medical Information – Please give details of any medical/health conditions both physical and mental that might affect the members participation in club activities:

Medical Information – Please give details of any specific needs the member has which may affect their participation:

Disclaimer – I the member, If under 18 parent/guardian’s. Agree that it is my responsibility to ensure that the members bicycles, helmets and clothing are safe to use and in good working order:

Yes
No

Disclaimer – I the member, If under 18 parent/guardian’s. Agree that it is my responsibility to ensure that the member is suitably dressed and prepared for 2 hours of outdoor activities in the weather conditions of the day:

Yes
No

Disclaimer – I the member, If under 18 parent/guardian’s. Agree That the memeber will have membership to British Cycling membership:

Yes
No

Disclaimer – I the member, If under 18 parent/guardian’s. Must have read, understood and will abide by Team Darenth’s riders code of conduct:

Yes
No

Disclaimer – Photographs of the member may be used by Team Darenth to promote the club on its website, in the media and on social media sites. Do you give Permission for your image to be used?:

Yes
No

I the member, If under 18 parent/guardian’s. Have read and understood the Team Darenth's Privacy policy:

Yes
No