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Adult Consent Form
Medical & Consent Adult
OrderID
BookingID
Name
First
Last
Email
About the course
What are your coaching goals for the day?
Experience & Fitness
Please describe your experience & fitness.
Consent
(Required)
Your booking is made on the basis that you accept that mountain biking and other cycling activities involve an element of risk, and that you accept that risk on that basis that, although is cannot be eliminated completely, it will be manage by WyeMTB inline with current best practice. Risk assessments can be provided when requested
I agree with the above statement and am happy
Course
Date
(Required)
We take lots of pictures and videos during our sessions. Are you happy for us to use them for marketing purposes?
(Required)
Yes
No
About you the Rider
Home Address
Address
Postcode
Mobile
(Required)
Date of Birth
(Required)
Day
Month
Year
Age
BC Number (British Cycling)
Emergency Contact Details
Emergency Contact Name
(Required)
First
Last
Emergency Contact Mobile
(Required)
Medical Information
Please complete this section in full: If anything changes before the course IT IS YOUR RESPONSIBILITY to inform the coach/guide or tutor of these changes, ideally on the morning of the session. One of WyeMTB employees will give you the opportunity during the course briefing to declare these changes – the change of information can be passed to us in complete privacy.
Please indicate if you are suffering from any of the below .
(Required)
Asthma
Diabetes
Epilepsy
Hay Fever
Any Heart Conditions
Recent surgery (last 12 months)?
Currently pregnant.
NONE of the above
Please give further details on checked item(s)
Do you have any other medical conditions that we need to be aware of?
(Required)
Yes
No
Please describe other medical issues.
