WEST LONDON CYCLING EVENT ENTRANTS  – PARENTAL CONSENT FOR 14 – 15 YEAR RIDERS, RIDING WITH A PARENT OR GUARDIAN OR ANY 16 – !7 YEAR OLD RIDERS

TOUR de RICKY EVENT 31 May 2025 – 16 and 17 year olds must have Parental Consent, 14 and 15 year olds must ride with a Parent or Legal Guardian.

PARTICIPANT DETAILS : Name of Under 18 Entrant: ________________________________________ Home Telephone ____________________________________________________

Date of Birth:___/___/___ Sex: M (  ) F (  ) Age Group 14 – 15 (  )  16 – 17 (  ) Address__________________________________________________________________________

________________________________________________Postcode:_________________________

PARTICIPANT DETAILS : Name of Parent / Legal Guardian (where participant above is accompanied compulsory for 14 and 15 year olds, optional for 16 and 17 year olds}: _________________________________________Home Telephone __________________________

Date of Birth:___/___/___ Sex: M (  ) F (  ) Age Group 14 – 15 (  )  16 – 17 ( ) Address___________________________________________________________________________

_________________________________________________Postcode:_________________________

EMERGENCY CONTACT DETAILS : Name:________________________________

Relationship to Participant(s):_________________________

Contact Telephone Number (including area code):_______________________________________

MEDICAL INFORMATION : Please make a note below of any medical conditions 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 then please consult your GP before giving permission for your child to take part in these activities._____________________________________________________________________ ____________________________________________________________________________________________________________________________________________________________________

If you have any reason relevant to the ride for which you wish to disclose ethnicity or religion, please do so here. We don’t need this information unless you feel there is a reason that it is relevant to your participation. Food is provided by third parties and not sold by us, therefore you may wish to check dietary options wish vendors. We believe that The Tea Shack at the start /  finish venue does have allergy options ________________________________________________________________

_________________________________________________________________________________. __________________________________________________________________________________Disability Information : The Disability Discrimination Act 1995 defines a disabled person as anyone with a “physical or mental impairment which has a substantial and long term adverse effect upon his/her ability to carry out normal day to day activities”. Do you consider yourself to have a disability? Yes □ No □ Prefer not to say □ If you do have any disability which may impede your ability to complete the riding distance on public roads, we recommend that you consider not entering. This is a low entry price event and we cannot provide extensive infrastructure to cover all eventualities and disabilities. You enter this event at your own risk.

PHOTOGRAPHS PERMITTED : Photographs of your child may be used for coverage of the event or promotional purposes. It is an accepted condition of entry and by signing this consent you grant permission.

Parent/Guardian Name …………………………………………………………………………………………………………………..

Parent/Guardian Signature ……………………………………………………………………………………………………………..