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Adult Waiver - To be completed by all riders aged 18+

Injury waiver and release of liability

“The Facility” means the cycle track and bicycle park at YMCA Newark and Sherwood

I acknowledge that this bicycle park is an extreme test of a person’s physical and mental limits and carries with it the potential for death, serious personal injury and property loss. The risks include, but are not limited to, those caused by terrain, facilities, man-made structures, temperature, lack of hydration, weather, equipment, vehicular traffic, and the actions of other people, including, but not limited to, participants, volunteers, spectators, coaches and/or builders of the park. These risks are not only inherent to athletes, but are also present for volunteers. 

I acknowledge that this Injury Waiver and Liability Release form (IWLR) will be used by YMCA Newark and Sherwood, and that it will govern my actions and responsibilities at their Facility.

In consideration of my application and permitting me to participate at this park, I hereby agree on behalf of myself, my executors, administrators, heirs, next of kin, successors, and assigns as follows:


(A) I certify that I am physically fit, have sufficiently trained to participate and have not been advised otherwise by a qualified medical person.

(B) I accept and assume all of the risks which exist in the activities offered. I also confirm that I choose to participate being fully aware of these risks, and that my participation is voluntary.

(C) I expressly agree to accept responsibility for all risks existing and inherent in any of the activities from time to time, and acknowledge that my participation in the activity is voluntary and that I am fully aware of the risks. As a result of participating I agree to accept any consequences except for death or personal injury caused by YMCA Newark and Sherwood’s negligence and/or breach of statutory duty.

(D) To the maximum extent permitted by law but subject to the non-excludable consumer guarantees implied pursuant to UK Consumer Law, in no circumstances will YMCA Newark and Sherwood, YMCA Robin Hood Group, their directors, officers, employees, volunteers, representatives, and agents, event holders, event sponsors, event directors, or event volunteers be liable in respect of any claim for any indirect or consequential loss or damage, including without limitation personal injury, financial loss, or for any punitive, exemplary, special, incidental or consequential loss or damage whether such liability arises in contract, tort (including negligence), equity, breach of statute or statutory duty or breach of any consumer guarantees

(E) I agree to indemnify the entities or persons mentioned in paragraph D from any and all liabilities or claims made by other individuals or entities as a result of any of my actions at the Facility.


I hereby consent to receive medical treatment which may be deemed advisable in the event of injury, accident and or illness at the park. I understand that at YMCA Newark and Sherwood, I may be photographed. I agree to the use of all my photo, film, video or film likeness for legitimate purpose by YMCA, sponsors, organisers and/ or assigns.

This IWLR shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law. I hereby certify that I have read this document and I understand its content.


PARENT/GUARDIAN WAIVER FOR MINORS (Under 18 years old): I agree that this release of liability and assumption of risk agreement is made on behalf of the below named minor and that all of the releases, waivers and promises contained in these conditions are binding on that minor participant. I also confirm that I have full authority as parent or legal guardian to agree to their participation in the activities and to bind them to this agreement.

Riders must wear a helmet conforming to British Standards at all times when riding a bike anywhere at the Facility

I Agree


Riders Code of Conduct

“YMCA” means YMCA Newark and Sherwood

I will:

  • Arrive for the session in good time to prepare properly
  • Pay the required fees when requested
  • Arrive with a working bike in a safe condition, with handlebar ends capped
  • Not use motorbikes, scooters or skateboards on the tracks
  • Respect YMCA’s equipment and others around myself during training and competition
  • Always wear a cycle helmet when cycling, without exception
  • Wear suitable clothing for all cycling activity sessions, and consider additional safety equipment such as gloves, elbow/knee pads etc.
  • Warm up and cool down properly on all occasions
  • Only use the cycle facility when supervised by YMCA staff and/or volunteers
  • Play within the rules of the track and respect YMCA staff and officials and all their decisions
  • Be a good sport by applauding all good performances
  • Control my temper – verbal abuse of YMCA staff, officials and other riders, or deliberately distracting/provoking another cyclist is not acceptable or permitted behaviour
  • Work equally hard for myself and my club – remember, both myself and my club will benefit from my behaviour
  • Respect the rights, dignity and worth of all participants regardless of their gender, ability, disability, cultural background or religion
  • Not smoke on YMCA premises
  • Not consume alcohol or illegal drugs of any kind on YMCA premises
  • Treat all participants in cycling as I would like to be treated – not bullying or taking unfair advantage of another participant
  • Co-operate with my coaches, YMCA staff and other riders – remember, without them there would be no competition
  • Thank YMCA staff and/or officials after sessions
  • Help to maintain the club’s facilities be that the track or the hire equipment, and return any hire equipment in the state I received it in

I Agree

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*
Medical Matters
Do you have any medical conditions or are they taking any medication, you feel we should know about? (include all details about, Asthma, epilepsy, Diabetes if applicable)*
No
Yes

Please include below any details of any medicines being taken, any allergies e.g penicillin, plasters etc or any special dietary or other treatments necessary. Leave blank if not relevant.
Declaration of Fitness *
I declare that to the best of my knowledge; I do not suffer from any medical conditions which might have the effect of making it more likely that they would be involved in an accident which could result in injury to myself or others
Declaration of Fact *
I also confirm that the information provided is correct and if any information changes I will notify the centre
Declarations
Do you understand there is a risk of injury involved when cycling?*
Have you read and understood this acknowledgement of risk and the codes of conduct for cycling? (if you have any questions please inform a member of staff)*
Do you understand failure to exercise due care could result in injury or death?*
Do you accept that you must ride only to your level of capability?*
Do you agree to abide by this document, the terms and conditions of the centre and the YMCA cycling codes of conduct?*
I HAVE HAD SUFFICIENT OPPORTUNITY TO READ THIS DOCUMENT. I HAVE READ AND UNDERSTOOD IT, AND I AGREE TO BE BOUND BY ITS TERMS*
Privacy and General Data Protection Regulations

To comply with GDPR we are required to gain your consent to collect and store your personal Data. YMCA robin Hood Group is the data controller. We require your Data to ensure that you comply with the Terms and Conditions of use of the centre. We will store your data correctly and will not disclose to any third party. At any time you can request a copy of your data free of charge. GDPR, makes provisions for you to have your data erased and removed. This is known as the 'right to erasure/ right to be forgotten'. When the data is held for the establishment, exercise or defence of legal claims we have the right to refuse to erase the data. For this reason, our insurers insist that we continue to hold your data for 3 years from the date of your most recent visit.


In the case of Under 18 year olds, this is extended to 3 years beyond their 18th birthday. If you make a written request for erasure of your data, this request will be logged and the data will be erased after the period above.


I consent to the YMCA Robin Hood Group Privacy and GDPR policy.*
Parent(s) or Court-Appointed Legal Guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Relationship*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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