Essex Trials and Jump Centre

New Riders Form

First Name

Last Name

Date of Birth

Age

Address

Town

County

Post Code

Telephone

Mobile

E-Mail

Emergency Contact details

First Name

Last Name

Relationship to rider

Home Phone

Work Phone

Disclaimer

I hereby apply to become a rider at the Essex Trials and Jump Centre as indicated above. I or my parent/guardian accept and agree that neither the organizers, officials, the landowners, sponsors or fellow riders shall be liable in any way, or in any circumstances for any damage or injury that I may suffer during, in connection with, or as a result of taking part in cycling activities at The Essex Trials and Jump Centre (ETJC). I will abide by the rules of the ETJC. I agree that I participate in this activity entirely at my own risk and that I must ride in a manner which is safe for all others and myself. I also declare that the bicycle I will ride is in good working order and properly maintained. I shall wear the necessary protective clothing suitable for the activity including a helmet and I will not go beyond my capabilities.

I have read and understood all Rules and Regulations as stated overleaf. (This must be completed for a successful application)

       Please tick if you would like to hear about our latest events (This does not affect your application)