Name of person booking *

First Name

Last Name

Age of participant(s)

Participants under 16 years of age require the supervision of a parent or guardian

15 and under

16-24

25-34

35-44

45-54

55-64

65 and over

Which service(s) do you require? *

Our LEARN TO RIDE and RETURN TO CYCLING sessions are usually held in Dartmouth Park and Hill Top Park, West Bromwich.

Learn to ride

Return to cycling

When would you like to ride? *

Please state preferred day and time. You may select more than one option. We occasionally have more availability than stated on the form which we can discuss when contacting you. We will contact you to confirm your appointment before requesting a payment to secure it.

Mon AM

Mon PM

Tue AM

Tue PM

Fri AM

Fri PM

Sat PM

Sun PM

How did you hear about PEDALS READY?

Internet search

Instagram

Facebook

Twitter

Word of mouth

Poster, leaflet, mail

Other

News and updates

Please select this box if you would like to receive occasional email offers and updates.

Sign me up!

Event waiver. (Unfortunately we will be unable to provide services without consent to these conditions.) *

I HEREBY ASSUME ALL OF THE RISKS OF PARTICIPATING IN THIS EVENT. I certify that I am physically fit, sufficiently prepared for participation in the event, and have not been advised to not participate by a qualified medical professional. I certify that there are no health‐related reasons or problems which preclude my participation in this Event. In consideration of permitting me to participate in this Event, I hereby take action for myself, my executors, administrators, heirs, next of kin, successors, and assigns as follows: (A) I WAIVE, RELEASE, AND DISCHARGE Pedals Ready, and its officers, directors, board members, employees and agents (collectively Pedals Ready) from any and all liability, including but not limited to, liability arising from the negligence or fault of Pedals Ready, for my personal injury, death or disability, property damage, property theft, or actions of any kind which may hereafter occur to me while participating in this Event. (B) I INDEMNIFY, HOLD HARMLESS, AND PROMISE NOT TO SUE Pedals Ready from any and all liabilities or claims made as a result of participation in this activity or event, whether caused by the negligence of Pedals Ready, or one of its sponsor partners or otherwise. I acknowledge that Pedals Ready is not responsible for the errors, omissions, acts, or failures to act of any party or entity conducting the Event on behalf of Pedals Ready. (C) I hereby consent to receive medical treatment which may be deemed advisable in the event of injury, accident, and/or illness during this Event. (D) We may take photographs and videos during your session in order to improve the quality of our services. We may also use these on our website, social media channels and marketing. Please indicate in the comments section of this form if you do not grant permission for us to do this. This waiver and release of liability shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law. I CERTIFY THAT I HAVE READ THIS DOCUMENT, AND I FULLY UNDERSTAND ITS CONTENT. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT AND I SIGN IT FREELY.

I agree to these terms in order to receive services from PEDALS READY.