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 : _____________________________________
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 : _________________