EmailMe Form - Abingdon Freewheeling Registration

Firstname *

Lastname *

Email *

Telephone Number *

Preferably mobile number

House Name/Number & Street *

Town *

Postcode *

Gender *

Age *

How did you hear? *

Preferred discipline *

• I agree to act safely and responsibly.
• I agree to adhere to the rules of the road and the countryside.
• It is my responsibility to ensure that maoueuvres are carried out safely.
• I am fit and healthy enough to participate in my chosen activities.
• My cycle is in a safe, legal and rideable condition
• I accept that Freewheeling cannot be held responsible for any personal injury, accident, loss, damage or public liability.
• I am 16 or over (see below for the consent form to be used for under 16s) *

Yes

Parent or Guardian details

If the rider is under 16 then we are required to have the details of the parent or guardian of the rider.

Name

First Last

Mobile Number

Format: 07xxx 123456

• I agree that I am aware of the demands of the chosen cycle rides
• I am completely responsible for the junior member throughout cycle rides
• I am completely responsible for the safety of the junior member throughout the event and for arrangements to get to and from the event

Yes

Personal Details

Ethnicity

Due to the nature of this question, please feel free to not answer it if you feel you shouldn't.

In the past week, on how many days have you completed a total of 30 minutes or more of physical activity, which was enough to raise your breathing rate? *

Do you have any long term illness, health problems or disability that limits your daily activities? *

No

Yes

If Yes, please give details:

Are there any other activities that you are interested in?

Abingdon Freewheeling will keep your personal details in compliance with the Data Protection Act 1998. Shall we add you to the Abingdon Freewheeling distribution list to be informed of news and events? *

Yes

No

GO Active will keep your personal details in compliance with the Data Protection Act 1998. Can we use those details to contact you with relevant Go Active promotions? *

Yes

No