Consent to Ride Form

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At the StreetLight Centre we strive to ensure a safe environment for all members and visitors to the skatepark and cafe. However, skateboarding, inline, scootering and bmxing at the park are a form of extreme sport and can carry a significant degree of risk. On occasion, people do get injured or die whilst undertaking these activities.

Before being permitted to use the facilities at StreetLight, we ask each member to complete this consent form. If you are less than 16 years old, the form must be signed by a parent or legal guardian. Each member must also provide personal details requested below. We will treat this information in confidence and will not release it without the signatory’s prior consent (unless in the event of an emergency to appropriate authorities or medical professionals). All staff and some volunteers are trained First Aiders and will give medical assistance to any member sustaining an injury or becoming ill whilst at StreetLight. Additionally, staff will obtain outside medical assistance if it is required. Again, parents or legal guardians must sign for any member who is below the age of 16 years old.

Written copies of the terms and conditions are available on line or at the centre – please read them carefully. We call them our ‘House Rules’ and they are in place for your safety and enjoyment. By signing this consent form, you are agreeing to abide by them at all times when you are on the premises.

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Rider Details

First Name

Surname

Date of Birth

Must be in DD/MM/YYYY format

Address

Postcode

Email

Email Address - Please provide your email address if you wish to receive latest news, updates, holiday club info etc... If you do not wish to received such information please leave blank. We will not pass on email address to any 3rd party unless we are required to by law.

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Medical Information

Medical Information / Existing Injuries

Failure to inform us of any medical condition puts you at risk and we accept no liability

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Emergency Contacts

First Contact

First Name

Surname

Phone

Second Contact

First Name

Surname

Phone

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I hereby acknowledge that I have received a written copy of the terms and conditions applicable to attend the StreetLight Centre Skate Park.
I have read them fully and agree to be bound by them. I understand that use of the facilities at StreetLight involves risk and can result in injury and/or death.
I agree to wear a suitable safety helmet at all times when on the skate park.

We also strongly recommend safety pads (consent is valid until we are contacted by the signatory).

I confirm that the member named is fit to undertake skateboarding, bmxing, scootering, and/or inline skating. The member is in general good heath at the time of signing.

I hereby consent to medical assistance being given to the named member by suitably trained staff members and/or volunteers.

Additionally I give consent for staff to seek outside professional medical assistance if required.

In the event of an injury or an accident, a member of the StreetLight staff will contact the emergency contact to inform them of what has happened. I also confirm that if any relevant medical condition develops after signing that I will inform the StreetLight staff and add the information to this form.

Terms and Conditions of using the park, our Video/photo and social media policy can be viewed at
https://www.streetlightproject.org.uk/termsandconditions

Declaration

You must tick at least one checkbox

I am 16 yrs old or over and I have read and understood the T's and C's of using the skate park

I am the parent/Guardian of the member stated above. I have read and understood the T's and C's of using the skate park. The Rider stated above has also read and understood the T's and C's of using the skate park

Print First Name

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