CHILD APPLICATION

Child Club Membership

Submit your annual Membership online

What does your Membership cover?

Have peace of mind knowing someone is looking after your concerns

so you can take care of the riding.

Access to Club facilities
Access to Club training events
Reduced rates for practice and racing
Regular updates
Access to British Cycling

£10.00

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PERSONAL DETAILS

First Name*

Last Name*

Address*

Address line one

Address line two

Address line three

County

Postal Code

Gender*

Date of Birth*

Select Date ×

Mobile Phone*

Mobile Phone Number

Home Phone

Home Phone Number

Email Address*

EMERGENCY CONTACT DETAILS

Contact Full Name *

Contact Full Name

Relationship*

Relationship to Contact

Contact Mobile Phone*

Contact Mobile Number

Contact Home Phone

Contact Home Number

Extra Contact Name

Extra Contact Phone

DISABILITY INFORMATION

Disability*

Disability Details

If Yes please provide details... All information provided is strictly confidential.

MEDICAL INFORMATION

Medical

Please provide details of any medical conditions the club should be aware of and any treatment recommended if symptoms occur

PERENTAL CONSENT

Participation Consent

I hereby consent to my Son/Daughter taking part in the cycling activity sessions and understand and agree that he/she participates in cycling activity sessions under the instruction of British Cycling qualified coaches entirely at his/her own risk.

Photograph Consent

I hereby give my consent to photographs of my child participating in BMX racing events/coaching/practise sessions to be used solely for the purpose of promoting Mid Lancs BMX Club through their website and on any advertising literature.

Payment Amount*

£10.00 Membership + £0.50 admin fees

Amount

£ 0 GBP

Payment Method*

Credit Card (Stripe)

Enter Card Details*

we do not store any information you provide