Rider Information Form

What is your previous mountain biking experience? *

New to mountain biking Regular mountain biker Returning mountain biker (not cycled for 1 year or more)

2. Emergency Contact Details

3. Medical & specific needs

Please give details of any disability, medical/health conditions or specific needs that might affect your participation in cycling and what support/modifications are needed. *

Please list any medications you take on a regular basis. (Please ensure that you bring adequate supplies of medication and dosage for the duration of the ride.) *

Are you allergic or sensitive to any medication (eg. penicillin), insect bites or food? ( If yes, please provide details) *

Yes No

4. Declaration & Consent

The following must be read and agreed.

I declare that the above information is correct and that the person in charge has my permission to authorise medical treatment in an emergency. If I have answered “yes” to one or more of the above questions in Section 3, I should seek medical advice before attending a ride. I agree to tell the mountain bike leader if there is a change in my medical condition. I understand that this information will be shared with other mountain bike leaders and that I cycle at my own risk. *

I agree I disagree

5. Insurance Cover

The ride is insured in respect of legal liabilities (third party liability). However, participants have no personal accident cover unless they have been specifically advised of this in writing by the organiser of the ride. It is the participants’ responsibility to arrange for any extension of insurance cover unless advised differently by the leader or the organiser of the ride.

6. Data Protection

MTB Guisborough respects individual privacy. The club obtains and processes “personal data” (as defined by the Act) for the purpose of administering its functions as a Community Amateur Sports Club and under relevant legislation. In addition, MTB Guisborough may use information for the purpose of fulfilling its statutory responsibilities under the Data Protection Act 1998.

Information will be kept secure and confidential and will only be disclosed to those parties who have a legal and legitimate need to know.