Parental Consent


This form need only be completed on your first race and will be kept by the Organisers  for the duration of the series.  Please advise any change of details.


PROGRAMME DETAILS :

Location : Goodwood Motor racing Circuit, Westhampnett, Chichester   PO18 0PH   

                          

PARTICIPANT DETAILS :

Name : ______________________________________________

Date of birth  _____/_____/_____               Sex : M               F    

Address :    ___________________________________________

  

                   ___________________________________________

Postcode :  _____________

British Cycling Membership Number : ______________________

Home Telephone : _____________________________________

Email address :     _____________________________________



AGE

Under   8 

Under  10

Under  12

Under  14

Under  16

Under  18

GROUP

       

EMERGENCY CONTACT DETAILS :

Name :  ___________________________________         


Relationship to Participant:  ___________________

Contact Number :  ___________________________


MEDICAL INFORMATION :

Please make a note in the box below of any medical condition you feel we need to know about e.g. asthma.  If you have any concerns about your child participating in any form of physical activity you should consult your GP before giving permission for your child to participate in this activity.






PARENTAL CONSENT NOTICE : I have read the information above and declare that I have the right to give parental consent, and hereby consent to my child taking part in this series of events.


PARENT/GUARDIAN      NAME :    __________________________________


PARENT/GUARDIAN      SIGNATURE :   _____________________________   



 DATE :    _________________