Somerset Road Club membership Form We are pleased to welcome you to our club. To ensure that we have the correct contact details for you, please insert the information requested below and submit this form with your membership fee. After submitting the form below PLEASE SEND your payment by bank transfer to Somerset Road Club Account Number: 11856073 Sort Code: 404404 Please put your surname as payee referance.

Dan Cox - Club Treasurer

If you are under 16 please also ask a parent or carer to sign this form before it is returned. We will also use this information to ensure that you are kept informed about club events. Fees: Under age 16 at 1st January - FREE. Over age 16 at 1st January but under age 18, membership is 5.00. Student/Retired/Unemployed is 5.00. Senior membership is 15.00 and Second Claim - 10, and Family Membership - 30. Membership runs from Jan-Dec. All first claim members are entitled to 10% from Bicycle Chain in addition to entitlement to participate in CTT Time Trials and much more. Youths are also eligible to free kit.

Alternatively, download our entry form and send it membership secretary: Cheques payable to Somerset Road Club"Click Here"

Contact Details

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 on his or her ability to carry out normal day-to-day activities." Do you consider yourself to have a disability?

Medical Information Please detail below any important medical information that our coaches/club should be aware of (e.g. epilepsy, asthma, diabetes, a recent injury, etc). Medical condition (s) and recommended treatment/actions to be taken if symptoms appear: 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 cycling activity sessions.

Emergency Contact Details Please indicate below the person who should be contacted in case of an incident/accident.

Parental Consent

For all UNDER 18's Have to complete and return a papper form showing full Parental Consent, you may use the online form, but your child can not ride untill we have recived the full writen Consent form.

Parental Consent Form Notes
1. It is part of the British Cycling Code of Conduct to ensure that reasonable steps are taken to establish a safe environment where young people can enjoy developing their cycling skills.
2. Parents/carers are welcome to stay and watch the session but this is not compulsory.
3. Young people are expected to remain in the session from beginning to end unless they have to leave early. If the young person has to leave early or is being collected by someone other than the parent/carer, the parent/carer must advise the coach of the details of the arrangement, including who will be collecting the rider.
4. It is the young person's responsibility to participate in cycling activities in a sporting manner.
5. Any young riders who persistently misbehave or put others in danger will be asked to leave the session.
6. It is the parent's/carer's responsibility to ensure that their child's bike is in a safe condition to ride.
7. A correctly fitting cycling helmet must be worn at all times during the cycling activity sessions.
8. For all children under 12 years, coaching sessions will take place at a traffic-free facility. Over 12s may be involved in coaching sessions that take place on the public highway. Young people are only invited to take part when the coaches feel they are sufficiently responsible for their own actions and have developed the necessary bike handling skills and fitness levels in order to cope with riding on the public highways. Please tick if you do not want your child to be involved in cycling activity sessions that take place on the public highways (See note 8 above).