CRCC Youth Consent Form

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This form should be completed by all riders participating in coached sessions or prescribed training from a British Cycling qualified coach.

A new form will need to be completed prior to each series of sessions starting.

Email *

Which series are you giving consent for? *

Hillyfields Cyclocross Autumn/Winter 2021/22

Participant's First Name *

Participant's Surname *

Gender *

Male

Female

Date of birth *

YYYY

Age *

Usual/preferred group (if known)

Group 1

Group 2

Group 3

Group 4

Clear selection

Address *

Post Code *

Emergency Contact Name and Number 1 *

Emergency Contact Name and Number 2 (optional)

Is your child a member of Colchester Rovers? *

Yes

Other:

I am happy for my son/daughter to be photographed/filmed for the following (names will not be attached to the photos in either case)

Website/Social Media

For training/coaching/assessment purposes

Medical and Specific Needs

It is your responsibility (or that of a parent/guardian/carer if under the age of 18) to provide the coach with details of any medical or health conditions, allergies, or dietary or other specific needs that might affect your ability to participate in cycling. Please note that a coach is unable to provide guidance or make decisions relating to medical or health conditions. Rather, if you have any concerns about participating in any form of physical activity, please consult with your GP before signing the consent form.

Please give details of any medical or health conditions, allergies, or dietary or specific needs that might affect your participation in cycling and what support/modifications are needed by the coach.

Please also list any medications you take on a regular basis.
(This information may be required by the emergency services in the event of an accident)

Details of any medical conditions

Parental/Guardian/Carer Consent for Riders Under the Age of 18

I have read and understood the information on this form and the coach has satisfactorily answered any questions I have asked. I understand and agree that my child participates in coached sessions and/or training prescription entirely at their own risk. I confirm that the information I have provided is correct and complete to the best of my knowledge.

Name and relationship to rider *

Send me a copy of my responses.

Submit

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