LeeValley Youth Cycling Club
Membership Application Form
APPLICANT / PARENT/ GUARDIAN
Name / Name
Sex / MALE / FEMALE / Relationship to Child
Date of Birth
Age
Home Address / Home Address (if different to Child)
Home Tel No. / Home Tel No.
E mail Address / E mail Address
Physical/
Medical Needs / Mobile Tel. No.
BC Licence No.

PLEASE NOTE

Cycling is an activity where there are risks of accidents occurring. For this reason it is essential that the parents/ guardians of each child are aware of the following safety points: -

  • Children must wear a helmet whenever cycling at the LeeValley Youth Cycling Club (LVYCC). It is the parent/guardian’s responsibility to ensure the child complies with this.
  • LVYCC does not provide a “child minding” facility. Parents/ Guardians should remain present during the club meeting. The parent/ guardian are responsible for ensuring the safety of the child and for ensuring their actions do not constitute a danger to other circuit users.
  • The safety and maintenance of a child’s own bike is the responsibility of the parent/guardian and not the Club’s responsibility.
  • LVYCC DOES NOT have exclusive use of the Redbridge Cycling Centre on a Saturday morning. There may be other users of the circuit either cyclists or pedestrians. LVYCC cannot be held responsible for the actions of these non club members.

DATA PROTECTION ACT NOTICE

  • Information will be held in line with the Data Protection Act.
  • I accept that as a condition of my/ my child’s membership of LVYCC the personal details above will be retained by the Club on a computer
  • As part of club promotional material or reporting of cycling events, photographs of members taking part in club activities may be used and issued to 3rd parties.
  • It is intended to produce a directory of members of the club to be available to other club members, containing the names, addresses and contact details of members and their guardians. Physical or Medical Conditions will not be disclosed. If you object to your information being disclosed in this way then please tick here 

I confirm that I have read and agree to the above notes and wish to apply to be a member of the LVYCC

SIGNED………………………………………………………………………DATED……………………………………………….

I confirm that I have read and agree to the above notes and consent to my child being a member of the LVYCC

SIGNED………………………………………………………………DATED………………………………………………..

[Parent / Guardian]