Making cycling easier Parent/Guardian Consent

Woman wearing helmet smiles as she pedals e-cycle in cycle lane

To ensure the safety and well-being of participants aged 16 and 17, we require a parental consent form to be completed for one-month loans.

Region where you are getting your one-month-loan

Luton & Dunstable

Manchester

One-month loan E-hub pick-up location (for example, Stretford Public Hall E-hub)

Date of one month loan pick-up

Booking reference

Name of participant

Participant's age upon booking

Parent or Guardian’s full name

Relationship to participant

Parent or Guardian's email address

Parent or Guardian's phone / mobile number

Consent

Please note that the contact details above will be used in the event of an emergency.

I hereby provide consent to the above-named participant to them receiving a one-month loan e-cycle, and will ensure they adhere to the relevant terms and conditions. I will take responsibility for any failure of the named participant to adhere to the terms and conditions.

By collecting your e-cycle you agree with our Terms and Conditions

www.cyclinguk.org/national-e-cycle-hire-terms-conditions-loans,

and our Privacy Notice

www.cyclinguk.org/article/making-cycling-e-asier-privacy-notic

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Making cycling easier Parent/Guardian Consent

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