Social Cycling - Session Information Form Use this form to sign up for cycling sessions. We will get back to you with a full confirmation shortly.Your detailsParticipant Full Name(Required) Participant Mobile Phone Number(Required) Participant Email address (or the person you are booking for) this will be used for the confirmation email.(Required) Participant Postcode(Required) What is your employment status?(Required)-- Please Select --EmployedEmployed -low wageUnemployedPrefer not to sayWhich borough do you live in?(Required) Times and datesWhich activities would you like to sign up to? Group Cycle Training: Mondays 10-12 Group Cycle Training: Wednesdays 10-12 Group Cycle Training: Wednesdays 13-15 Wellbeing Rides: Tuesdays/Thursdays 10-12 Ride Leader Course All Ability Cycling Club Which activity would you like to sign up to?Select Course...BeginnerImproverCycling For WellbeingRide Leaderyou can select more than one activtyBeginner sessions are 2 hours long and are for people who have never ridden a bike before or cannot ride a 2 wheeled cycle without someone supporting them. Maximum two sessions per person (2nd session booked after 1st session is completed)Improver sessions take place in a park or off road and is designed to improve basic cycling skills prior to attending Cycle for Wellbeing or On Road courses.Make new friends and explore green spaces in this welcoming, fun group. Be introduced to volunteering and wellbeing techniques on a course structured around the 5 Steps to Wellbeing. 8 sessions over 4 weeks. You must be able to balance on a cycle to take part in this course.Bikeworks delivers a Ride Leader course to enable people to plan and deliver rides with mixed ability groups on, and off-road. It is a practical course which includes some theoretical elements. All participants must come with their own cycle.Preferred Day (Beginner) Mondays, Dalgarno Trust 10am-12pm Wednesdays, Henry Dickens Court 10am-12pm Chelsea Riverside (not yet confirmed, please register interest) Preferred Date (Improver) Mondays, Dalgarno Trust Wednesdays, Henry Dickens Court Chelsea Riverside (not yet confirmed, please register interest) Cycle For Wellbeing Tuesdays & Thursdays 10am - 12pm Starts 18th April Tuesdays & Thursdays 10am - 12pm Starts 16th May Tuesdays & Thursdays 10am - 12pm Starts 20th June Ride Leader Course Wednesday 29th March 10am - 1.30pm Wednesday 12th April 11am - 2.30pm Wednesday 3rd May 10am - 1.30pm Are you interested in any of the other course types- we will contact you directly about these once you are booked for your first session or course).About You:How do you describe your current cycling skills?(Required) I cannot balance using a 2-wheel cycle on my own I can ride a 2-wheel cycle, but lack confidence I can ride a 2-wheel cycle and feel in control of balancing and I can avoid hazards I can ride a 2-wheel cycle and cycle both off-road and on-road Using a non-standard cycle. I would like to take part using an adapted cycle Do you want to borrow a free cycle from us during the course?(Required) No, I have my own cycle and it’s roadworthy Yes, a 2-wheel cycle (standard) Yes, an adapted cycle (non-standard) Yes, but not sure which one, please advise me Do you have a health condition we should be aware of? Do you have any additional support needs we should be aware of? We ask this so we can minimise any barriers and provide you with a great experience. Please provide an Emergency Contact Name and Number (not your name or number)(Required) Monitoring informationAll information you provide is anonymised and provided back to the funder enabling us to deliver free sessions.How did you hear about this programme?(Required) Referral from GP/ Nurse/ Social Prescriber/ Community Connector, or similar Referral from other professional Word of mouth Bikeworks promotional material An external website or social media, e.g council website Other Demographic InformationThis does not affect your booking and is anonymised and used for monitoring purposes only. If booking on behalf of someone else answer to the best of your knowledge or select “Prefer not to say”.Date of Birth(Required) MM slash DD slash YYYY Gender(Required)-- Please Select --Non-binaryFemaleMaleOtherPrefer not to sayEthnicity(Required)-- Please Select --White: BritishWhite: IrishWhite: Any Other White BackgroundMixed Race: White & Black CaribbeanMixed Race: White & Black AfricanMixed Race: White & AsianMixed Race: Any Other Mixed BackgroundAsian/Asian British: IndianAsian/Asian British: PakistaniAsian/Asian British: BangladeshiAsian/Asian British: Any Other Asian BackgroundBlack/Black British: CaribbeanBlack/Black British: AfricanBlack/Black British: Any Other Black BackgroundChineseAny Other Ethnic GroupPrefer Not to SayDo you consider yourself to have a disability?(Required)-- Please Select --Blind/Visual imparementNoPrefer Not to SayDeaf/Hearing imparementLong term health conditionMental health difficultyMobility imparementMultiple DisabilitiesNeuro-diversity (e.g. ADHD, Autism)Neurological condition (Alzheimer's, Epilepsy)Nearly doneI give permission for photos of myself to be used publicly(Required) Yes No You will need to agree to the terms and conditions to participate, please see below.Do you agree with the terms and conditions?(Required) I consent to the terms and conditions A copy will be sent to you by email once you submit the form.Cycle Training Terms and Conditions By signing up for a cycling activity with Bikeworks CIC, you or Carer/ Guardian (now referred to as ‘the Participant’), is entering into an agreement between Bikeworks and the Participant which relates to all cycling activities run by Bikeworks CIC on or after the date of sign up. By doing so, you understand that: • The Participant accepts that the instructors may, at any time, refuse to continue with an activity or session if their behaviour or ability level is deemed to be unsuitable. • The instructors may refuse to train The Participant if they deem their cycle to not be roadworthy • It remains The Participants’ responsibility that they ride a roadworthy cycle. If they are in doubt, advice should be sought from a professional cycle mechanic. • It is the decision of The Participant whether to wear a cycle helmet and this must be safe and suitable for use. • If The Participant chooses not to wear a cycle helmet on a training course, The Participant understands that Bikeworks will not be held liable for the result of any injury, which may have been prevented by the wearing of a helmet. • The Participant understands that Bikeworks CIC is not responsible for any injury or any loss or damage to any property which is not caused by an instructor’s negligence Bikeworks CIC takes no responsibility whatsoever for any injury or damage to any property which occurs either on the way to or from the lesson or subsequent to lessons. • The Participant understands that having taken training it does not necessarily follow that it is safe for them to ride a bicycle. To become a proficient cyclist takes much more practice than lessons of this kind can provide. • The Participant understands the personal details held by Bikeworks CIC may be passed on to the funding providers of this training and that they may contact them to ask for details of the lesson. Cycle training will be delivered in line with current health and safety guidance, including Public Health guidance. Δ
