Secondary schools level 3 Bikeability Consent Form

Consent for storing submitted data *

Yes, I give permission to store and process my data

No, I don't consent to storing and processing my data

Name of child *

Form class *

Please state your child's class form

Do you agree to the above student taking part in the above course and confirm you have read the information supplied? *

Yes

Do you agreed that in the event of an emergency I consent to the above named child receiving any medication or treatment deemed necessary by the authorities present if I can not be contacted at the number given below? *

Yes

Has your son/daughter received the Bikeability – Level 2 training? *

Yes

If yes, please give the name of the school the training was done and the date completed

Name of parent/guardian *

Relationship to child *

Address *

Postcode *

Email address *

Mobile number *

Please enter your mobile phone number. A reminder SMS text will be sent on the morning of the lesson.

Please list any medical/ SEN or other information you think necessary to assist the training and safety of your child. Include allergies or current medication as appropriate.

Does your child require a school loan bike or helmet?

To facilitate cycle training at the school, the school will make bikes and helmets available to students if required.

Does your child wish to use a school loan bike? *

Yes

Does your child wish to use a school loan helmet? *

Yes

Please note

Loaded cycles will only be available on the condition the school agrees to store cycles securely for the duration of the training programme

The Bikeability Trust is required to collect information about rider characteristics in the delivery and monitoring of cycle training across England. This data will enable to Trust to demonstrate the need for additional funding and target interventions to ensure every child can receive Bikeability cycle training.

Please state the gender of your child *

Male

Female

Other

Prefer not to say

Is your child eligible for free school meals? *

Yes

Prefer not to say

Darlington Borough Council Online Forms

Secondary School Bikeability Level 3 Training

Does your child require a school loan bike or helmet?

Please note