REGISTRATION FORM - Sara Carrigan Cycling
City of Gold Coast Bicycle Workshop
Which Workshop are you registering in?
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Absolute Beginner Workshop
Adult Skills Workshop
Commuter Workshop
Weekend Pathway Ride
Other
Date of Workshop
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Year
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Month
Day
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Have you previously registered (for a different workshop)?
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Register as a new rider
Register as a returning rider
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Particpant Details
Full Name
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First Name
Last Name
Gender
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Male
Female
Mobile Number
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E-mail
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Date of Birth
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yyyy
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mm
dd
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Age
Address
No, Street, City, Postcode, State
Emergency Contact
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Name, Contact Number, Relationship
What riding have you been doing lately?
Exercise History & Cycling Experience
1. How often do you currently...
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Never
Once in last 6months
1 x fortnight
1-2 x week
3-4 x week
>4 x week
Ride your bike?
Engage in non-cycling exercise?
2. How do you rate your current level of confidence about...
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1 (Low)
2
3
4
5
6 (High)
Riding?
Riding in traffic?
The road rules, responsibilities & etiquette of cycling?
Planning your route & finding information about cycling?
3. How do you rate your current level of fitness?
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Below Average
Average
Good
Very Good
Excellent
Fitness
4. What type of bike will you be riding?
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Road Bike (Skinny tyres, curly handlebars)
Hybrid (Flat bar, medium tyres)
Mountain Bike (Knobbly tyres)
Cruiser Bike
Other
5. Do you have cycling shoes with cletes & 'clip-in' pedals?
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No
Yes
6. Can you ride with one hand (for drinking, signalling etc)
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No
Sort of
Yes
7. What is the longest ride you have done?
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8. What do you wish to learn?
8. What are your expectations of this workshop?
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9. Any health issues?
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10. How did you hear about this?
11. Other notes
Declaration and Informed Consent
Terms and Conditions
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I have read, understand and agree to the Terms and Conditions for participation in the Cycling Program (www.saracarrigan.com/TCs)
Bike & Safety
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I understand that it is my responsibility to bring my bike well maintained, with all safety gear – including Australian Standards helmet & brakes in good working order.
If I am in doubt as to the maintenance status of my bike, I will have it assessed, and if necessary repaired, by an experienced bike mechanic / bike shop BEFORE the ride.
I have familiarised myself with these safety elements, such as my helmet, tyre pressure, QLD Road Rules & a bike safety checklist here: www.saracarrigan.com/safety
Participant Name
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First Name
Last Name
Name of parent/legal guardian (if participant under 18)
Date of Registration
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Year
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Month
Day
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