Cycling Booking Form

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NWActive are delighted to be teaming up with Park Lane Primary School to bring you this exciting community cycling project. We are aiming to increase the number of children able to cycle independently and promote active family experiences through cycling. All sessions are FREE and bikes/helmets will be provided for all children.

Use the form below to book for any of the sessions. You will be contacted to confirm your place(s).

Please note that all instructors are fully qualified Bikeability DBS checked instructors. Both Park Lane Primary School and NWActive are committed to safeguarding and promoting the welfare of children and expect staff, volunteers and visitors to share this commitment.

Which session are you booking for? *

Balance Bikes (3 session block 3rd, 10th & 17th Feb)

Learn to ride (3 session block 17th, 24th Feb & 2nd March)

Level 1 (1 session)

Fix (1 session)

Family (1 session)

Introduction to pedals (4 session block)

Child name (enter more than one if you wish) *

Child date of birth *

Postcode *

Medical conditions *

My child will use their own cycle *

Yes

Phone number *

Email *

Emergency contact name *

Emergency contact number *

Second emergency contact number *

Other supporting information (optional)

Terms and conditions

PARENT/ GUARDIAN – CONSENT FORM Please read the following information before completing and returning the consent slip to your child’s school. I understand that:

1. I agree to my son/daughter taking part in cycle training

2. Instructors may at any time refuse to continue to train my child if his/her behaviour or cycling ability is deemed unsuitable

3. NW Active will not be responsible for any injury or liable for any loss or damage to participant’s cycles and other belongings.’

4. I agree for my child to wear a helmet.

5. I consent to the Bikeability instructor ‘adjusting’ my child’s helmet if required, however I confirm they are not responsible for the physical condition or appropriate fitting of the helmet.

6. I understand that pupil data collected will be used to support the delivery and monitoring of training sessions/courses. Data is stored for the duration of the course.

See bikeability.org.uk/privacy-statement/ for further details.

7. I agree to encourage my child to practice between each session and after the completion of training

I give consent for my child to be photographed/filmed for promotional purposes *

Yes

I would like to be kept informed of future Bikeability and opportunities through NWActive *

Yes

I agree to the terms and conditions *

Yes

Required

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