Confidential When Completed
Sprockets Cycle Club Consent Form
It is necessary to obtain consent for your child to take part in activities run by
Sprockets Cycle Club. If you wish your rider to participate then please read the
following information and complete and sign the consent form. By completing
and returning this form you consent to the named rider taking part in coaching
sessions and understand that your rider participates in coaching sessions under the
instruction of British Cycling qualified coaches. Sessions will cover a variety of
games, activities and races and will be conducted on traffic-free areas. Some
coaching may take place at a distance from the primary coaching site, but in this
case guided rides will move the riders from place to place under coach supervision.
Contact Details
Parent / Guardian
Name(s):
House Number/Name:
Address and
Postcode:
Emergency
Number(s):
Home:
Mobile:
Contact Email:
This is our preferred method of contact, please provide a clear email address.
Rider Name:
Current Age:
School College:
Date of Birth:
Medical/Disability Information
Are there any medical or disability details that the club should be aware of ? Yes

No

Medical Details:
Disability Details:
Photography and Video Information
Photographs and video may occasionally be taken by Team Sprockets for use in publicity material or
videos taken for coaching purposes, Publicity will also include use of Social Media. If you do not wish
photographs or video to be used in this way, please tick this box 
Parent / Guardian Name(s):
Signature
Confidential When Completed