Rider DetailsName First Last Date of Birth DD slash MM slash YYYY Gender Male Female Rider Level(Required)---Please Select---BeginnerIntermediateAdvancedList any relevant medical conditions Repeat Customer? Yes No Contact DetailsState(Required)NSWACTPostcode(Required) Email Address(Required) Enter Email Confirm Email Mobile Number(Required)Emergency Contact Name(Required) Emergency Contact Number(Required) PollWhere did you hear about us?(Required)---Please Select---GoogleWord of mouthSaw us at an eventRepeat RiderNewspaper/print mediaSocial MediaBike ShopOtherDo you prefer weekdays or weekend events?(Required) Weekday Weekend Consent(Required) I AgreeI have carefully read the below Consent Form in its entirety and agree to be bound by the terms and conditions found in the Waiver and Release of Liability, Assumption of Risk and Indemnity 1. In consideration of Bike and Fitness accepting my participation in any training/coaching session, packages, event conducted by Bike and Fitness which may involve a significant risk of physical harm, I agree to this release of claims, waiver of liability and assumption of risk. I am aware that mountain biking and cycling in general is a recreational activity which may involve, in addition to usual, obvious and inherent risks, personal injury and the possibility of injury and harm and physical exertion for which I may not be prepared. Furthermore, I am aware that this activity could involve remoteness to normal medical service, weather extremes subject to sudden and unexpected change and evacuation difficulties if I am disabled. 1.1 I accept all of the inherent and obvious risks and that mountain biking and cycling in general is a dangerous recreational activity and the possibility (however remote that may be) of personal injury, death, property damage or other loss resulting there from. I acknowledge that I freely accept the usual, obvious and inherent risks incurred by the activity of mountain biking and cycling in general beyond the accepted safety of life at home or work and that these inherent risks contribute to my enjoyment and excitement and are therefore reasons for my participation. 1.2 I hereby release and forever discharge from all liability and agree not to sue Bike and Fitness and its officers, employees, volunteers, agents, contractors, sub-contractors, public bodies, land holders and sponsors from any and all claims, suits, demands, expenses, costs, damages or proceedings of any nature whatsoever arising from any personal injury, death, property damage or loss sustained by me as a result of my participation in a training program, session or event. 1.3 I hereby indemnify and hold harmless Bike and Fitness, its officers, agents, contractors, sub-contractors and sponsors from and against all claims, suits, demands, expenses, costs, actions and proceedings of any nature whatsoever arising from any injury (inclusive of Ambulance fees), loss or damage sustained by me or any injury, loss or damage suffered by any other person as a result of any act, omission, neglect or default on my part in connection with my participation in a training program, session or event. For insurance for yourself please see the membership products from AusCycling https://www.auscycling.org.au/membership. You are not otherwise insured by us and you have agreed to this waiver disclaiming any liability against us". Participant I confirm that I am an age of legal consent (that is 18 years or older in Australia) and that I have read, understood and been given every opportunity to discuss this Assumption of Risk and Waiver of Liability Agreement, plus the Terms and Conditions prior to signing it, and agree that this agreement will be binding upon me, my heirs, next of kin, executors, administrators and successors. Under 18 I, parent/guardian of the registered participant consent to my son/daughter participating in the event organized by Bike and Fitness and confirm that I have read, understood and been given every opportunity to discuss this Assumption of Risk and Waiver of Liability Agreement, plus the Terms and Conditions prior to agreeing and agree that this agreement will be binding upon me, my heirs, next of kin, executors, administrators and successors. I acknowledge and accept that the sport of cycling carries a degree of risk of injury. I agree to obey all the AusCycling rules, directions, and decisions of all AusCycling Teachers and officials whilst I am participating in the AusCycling Cycling Training course. I hereby agree to allow the photographs, video, audio recordings, multimedia or film likeness to be used in the media and by AusCycle, Bike and Fitness, the sponsors, or assigns for the purposes of promoting AusCycling, Bike and Fitness, the AusCycling Cycling Training course and the sport of cycling. You acknowledge and agree that the information provided will be used. Full Name of Rider or Parent/Legal Guardian(Required) Date(Required) DD slash MM slash YYYY Package SelectionSelect Package(Required)---Please Select Package---Kids Squads Term 2, 2025Barrington Beginner TBABarrington Intermediate/Advanced TBA6 Hour Kids School Holiday Program4 Hour Kids School Holiday ProgramKids Private MTB 90mins LessonKids Private MTB 120mins2 Hour Adults Group MTB Program2.5 Hour Adults Group MTB ProgramAdults Private Lesson 90minsElite Race Program per sessionExtra Participant MTB PrivateOne Day Term SquadKids Party GlenrockPlease Select Day(Required)Please Select DayMonday - 4:15PM StartWednesday - 4.15pm StartThursday - 4.15pm StartPlease Select Preferred Day(Required)---Please Select Preferred Day---Mon-FriSaturday - AMPlease Select Preferred Day(Required)---Please Select Preferred Day---Mon-Fri and Sat AMPlease Select Preferred Day(Required)---Please Select Preferred Day---GLENROCK - April 9am to 3pmPlease Select Preferred Day(Required)---Please Select Preferred Day---GLENROCK - Tuesday 8th July 9am to 1pmGLENROCK - Wednesday 9th July 9am to 1pmGLENROCK - Thursday 10th July 9am to 1pmGLENROCK - Tuesday 15th July 9am to 1pmGLENROCK - Wednesday 16th July 9am to 1pmPlease Select ProgramPlease select programAdult Beginner/Intermediate TBA 9.30am to 11.30amPlease select datePlease select dateFriday TBA 9.30am to 12.00pmDo you have an active kids voucher?(Required)NoYesPlease Enter Your Active Kids Voucher Code(Required) Total Credit CardCard Details Cardholder Name Captcha
