Rider Information and Consent form

This form should be completed by all riders participating in Coached or Guided sessions from Louise Haggarty / Headinthesky MTB Coaching.

Name

First Name

Last Name

Phone

Country

(###)

###

####

Date of Birth

Emergency Contact Full Name

Relationship to Rider

Phone

(###)

###

####

Medical Information

It is your responsibility 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.

Medical Information

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

Medication

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

Rider Consent

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 I participate in Coached or Guided sessions entirely at my own risk. I have considered the nature of such sessions; I will participate in a safe manner and follow all reasonable instructions from the coach. I confirm that the information I have provided is correct and complete to the best of my knowledge.

I agree

Date

YYYY

Consent for appropriate photographs and videos for coaching and marketing purposes

Yes