Dirt Maidens Registration Form Name * First Name Last Name Phone * (###) ### #### Age * Email * Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Emergency Contact Name * First Name Last Name Emergency Contact Phone * (###) ### #### Do you have any medical condition/s that your instructor should be aware of (e.g. asthma)? * No Yes If you answered 'yes' to the above, please give details below. My goals for the session/s are: Where did you hear about us? * Dirt Maidens Fb page Facebook Ad Instagram Ad Friend/family member Word of mouth Other I accept the Terms and Conditions of this booking as outlined on the website * Yes Waiver * Mountain Biking can be an inherently dangerous activity by design. Dirt Maidens will provide you or your child with instruction in an appropriately safe working environment and provide you with a fully qualified and insured instructor. Participants will not be placed under any pressure to perform skills or ride any sections of trail if they do not feel comfortable in doing so. ACKNOWLEDGEMENT – I acknowledge that cycling involves a risk of injury and/or death and damage to property. Further to the above, I understand that there is an inherent risk in undertaking a Session. For example (but not limited to): I may be injured, physically or mentally, or may die; my personal property may be lost or damaged; other persons participating in a Session may cause you injury or may damage your property; I may cause injury to other persons or damage their property; the conditions in which the activity is conducted may vary without warning; and on that basis I agree to assume the risk of, and responsibility for, any injury, death or property damage resulting from my participation in the activity. AMBULANCE & MEDICAL TREATMENT In the event of an emergency, I authorise Dirt Maidens to request an ambulance on my behalf (and I agree to bear the expense of that ambulance) and I agree to receive (and bear the expense of) any first aid provided by a qualified person or registered medical personnel. I have read and accept the above waiver Thank you for booking a clinic with Dirt Maidens!Please take some time to read through some pre-clinic information prior to your session. This includes what to wear, bring, and a bike safety check. For this information, please click here.Looking forward to riding with you :)Warm regards,Claire