Are you registered disabled / do you have a disability? *
Do you have caring responsibilities? *
I give consent for my photo to be taken and shared as follows:
Please tell us about any Health Conditions you have
Your answer
Do you own a bike that is in good working order? (please note that for the one to one training you will need your own bike) *
Are you experiencing any COVID-19 symptoms? *
Any other information you would like to tell us about yourself, your experience with cycling, or days when you are available (including Saturdays)?
Your answer
Please tick the box below to confirm that you have read the COVID-19 information sheet that was sent with this form. *
Required
I acknowledge that I take part in cycle training at my own risk, and that Darnall Well Being cannot be held responsible for any personal injury, accident or damage sustained during the training.
A copy of your responses will be emailed to the address you provided.