Consent Form

Name

First Name

Last Name

Date of Birth

MM

DD

YYYY

Previous MTB experience:

New to MTB

Regular MTB rider

Returning MTB rider (not cycled for 3 months or more)

Have you participated in guided MTB rides before?

Yes

No

Do you ever cycle on the road?

Yes

No

Is your preference for an MTB route or a Gravel Bike route ie: 50:50 minor road/off-road, canal towpaths and less climbing

MTB route

Gravel Bike route

Name

First Name

Last Name

Cotswold Mountain Biking would like to take photos and videos on the rides and use them for marketing purposes, this includes social media and website materials. Please note your preference below

Opt in

Opt out

Do you consider yourself to have a disability?

Yes

No

Prefer not to say

If yes what is the nature of your disability?

Hearing

Learning

Mobility

Multiple

Physical

Visual

Other

Prefer not to say

Do you suffer from any of the following conditions?

Asthma

Anaphylaxis

Bronchitis

Diabetes

Fainting

Migraines

Angina

Raised blood pressure

Epilepsy

Are you allergic or sensitive to any medication (eg Penicillin), insect bites or food?

Yes

No

Declaration

I understand that I cycle at my own risk and I declare that the above information is correct and that the person in charge has my permission to authorise medical treatment in an emergency. I acknowledge that mountain biking involves risk and that I accept that risk on the basis that, although it cannot be eliminated completely, it will be managed by the guide, by implementing appropriate risk assessments, in line with current best practice.

I Agree