Membership Number:
Salt Ayre Cog Set
www.cogset.org.uk
Parental/Carer Consent & Membership Form
SECTION 1 : PARENTAL/CARER CONSENT
PARTICIPANT’S DETAILS:
Name :
BC Category
(if known)
Date of Birth :
Address :
Post Code :
Parents email address :
*Participants email address:
*All emails will be copied to parents
Home Tel :
Emergency Contact Details
Name :
Mobile No:
Relationship to Participant :
Contact Tel :
Please make a note of any medical conditions you feel we need to know about below. If you have any
concerns about your child participating in any form of physical activity then please consult your GP
before giving permission for your child to take part in the Go-Ride Activities.
Notes :
1. It is part of the British Cycling Code of Conduct to ensure that reasonable steps are taken to
establish a safe environment where young people can enjoy developing their cycling skills.
2.
The Salt Ayre Cog Set Cycling Club is open to children aged 6-18. Children younger than 8
must be accompanied by an adult.
3.
If the young person has to leave early or is being collected by someone other that the
parent/carer, the parent/carer must advise a committee member of details of the arrangement,
including who will be collecting the rider.
4.
It is the young person’s responsibility to participate in cycling activities in a sporting manner.
5.
All riders must adhere to general standards of good behaviour. Any young riders who persistently
misbehave or put others in danger will be asked to leave the session.
It is a parent’s/carers responsibility to ensure that his/her child’s bike is in a safe condition to ride.
A correctly fitting cycling helmet must be worn at all times during the cycling activity sessions.
Please note that the Salt Ayre Cog Set may take photographs/video footage at Club/Go-Ride Events.
These could be placed on the club website or used for general publicity purposes.
If you object to photographs/video footage of your child being used in this way, please tick this box.
The name of your child will not be published without first seeking permission.
6.
Salt Ayre Cog set use “Groupspaces” a group management tool and also British Cycling Club Management
Tool to manage member information and email any club information.
If you do not wish your email address to be added to Groupspaces, please tick this box.
If you do not wish your email address to be added to the British Cycling database please tick this box.
I being the parent/carer of
have
read
the
information contained in this notice and hereby consent to my child taking part in the coaching
sessions and understand and agree that my child participates in coaching sessions under instruction
by British Cycling accredited coaches entirely at his/her own risk. *I have considered the nature of
such sessions and have discussed them with my child. I am satisfied that my child is sufficiently
responsible and competent to assume full and entire responsibility for his/her own safety under the
supervision of a British Cycling accredited coach.
PRINT NAME (Parent/Carer):
Signed (Parent/Carer):
I agree to abide by the club rules*
Signed (Junior) :
Date:
(*applies to over 8’s only)
Cog Set Consent Form - 2016
SECTION 2 : JUNIOR MEMBERSHIP
Name :
Date Paid :
A Membership fee of £12 per year is payable per child, after the third session - plus £2.50 weekly subs.
The Cog Set Membership Card currently gives you the following
(youths/juniors only):
Up to 10% discount at the following cycling shops :
(various goods – at Management discretion)
 Biketreks – Ambleside
 The Edge Cycleworks – Lancaster
 Evans Cycles – Kendal
 Leisure Lakes - Lancaster **
 Wheelbase Lakeland Ltd – Staveley
**offering up to 12.5% discount on purchasing items that are not at an offer price or on promo. Also 10% off
the price of all none offer bikes!
DON’T FORGET TO SHOW YOUR CARD!
Reduced rates on servicing and repairs to all Cog Set members
James Williamson - Freewheel Mobile Cycle Technician
Contact [email protected] – 07814 667 990
 You can attend various Cog Set social events throughout the year (junior and senior members):
Cog Set Summer BBQ, Club Championships and Awards Evening etc.,
Please provide details regarding your participation in sports, cycling experience or goals etc.
It is recommended that all club members join the British Cycling Federation in order to obtain third party
insurance cover. In addition, any member who wishes to partake in cycle racing will require a Racing
Licence. Licences are included free with all Youth memberships. Please log onto ‘britishcycling.org.uk’
or contact a Club Coach for further details.
SECTION 3 : SENIOR MEMBERSHIP
Membership Number:
British Cycling coaches and parent/senior members (over 18) run the Salt Ayre Cog Set.
If you would like to join as a senior member (free of charge), please complete your details below.
PRINT NAME :
Signature :
Only complete the following information if different to overleaf:
Address :
Home Tel :
Mobile No:
Email address:
Do you have British Cycling CRB/DBS clearance?
Y/N*
*If yes, please provide certificate number & expiry date
*If no, we will help make the necessary arrangements.
We always need help to run the Saturday morning sessions. If you are able to assist in any way please contact a
committee member.
Membership Secretary :
Carmen Jackson, 37 Chapel Lane, Overton, Morecambe, LA3 3JA
(email : [email protected] or
[email protected] – tel 01524 858336 – 07864 969514)
Please return completed forms to the membership secretary on the first session you attend.
Membership payments can be done on line at https://www.britishcycling.org.uk/club/subscriptions?&club_id=914
or by cheque (cheques payable to ‘Salt Ayre Cog Set)
Cog Set Consent Form - 2016