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Horwich Ride Social
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Horwich Ride Social
Navigation Menu
Navigation Menu
Home
About Us
How HRS Started
What We Do
Meet The Team
Come And Join Us
Policies
Adventures
News and Articles
Calendar Of Events
Contact Us
Name
*
Phone
*
Date of Birth
*
Email Address
Emergency Contacts
Name
*
Phone
*
Relationship to participant
*
Health and Safety
Gender
*
Please Select
Female
Male
Prefer not to say
Ethnicity
White English, Welsh, Scottish, Northern Irish, or British
Irish
Any other White background
Mixed or Multiple ethnic groups
White and Black Caribbean
White and Black African
White and Asian
Any other Mixed or Multiple background
Asian or Asian British
Indian
Pakistani
Bangladeshi
Chinese
Any other Asian background
Black, African, Caribbean or Black British
African
Caribbean
Any other Black, African or Caribbean background
Other ethnic group
Arab
Any other ethnic group
Prefer not to say
I give permission for the use of photos or other media featuring me (or the person for whom I'm completing this form)
*
Yes
No
I give permission to receive emails from Cycling UK via Upshot
*
Yes
No
Cycling information (for new participants)
How much do you agree with the following statement? “I intend to cycle more in the next few months"
*
Please Select
Strongly agree
Agree
Neutral
Disagree
Strongly disagree
Roughly, how often do you cycle?
*
Please Select
Never
Not in the last year
Once or twice a year
Monthly
Fortnightly
Weekly
More than once a week
What are your motivations for attending? (Tick all that apply)
Fix / Service your bike
Learn to maintain my bike
Go on a bike ride
Learn safety tips
Learn to ride
Receive cycle training
Build confidence on a bike
Meet new people/ socialise
Explore my neighbourhood
Improve my physical health
Improve my mental wellbeing
How do you normally travel to work or education
*
Please Select
Car
Cycle
Walk
Public transport
Other
N/A
How do you normally travel for other everyday activities
*
Please Select
Car
Cycle
Walk
Public transport
Other
N/A
Moderate physical activity is any activity that raises your heart rate and makes you breathe faster. How much moderate activity have you done in the last week?
*
Please Select
0–30 minutes
30 minutes – 2.5 hours per week
More than 2.5 hours per week
Prefer not to say
Do you have any long-term physical or mental health conditions or illnesses lasting or expected to last 12 months or more?
*
Please Select
Yes
No
Prefer not to say
You are disabled under the Equality Act 2010 if you have a physical or mental impairment that has a "substantial" or "long-term" negative effect on your ability to do normal daily activities. By this definition, do you consider yourself disabled?
*
Please Select
Yes
No
Prefer not to say
If yes, please feel free to provide further information that may be relevant or useful to help us understand any challenges you may face.
Confirmation
Privacy Notice
I accept the organisation's Terms & Conditions and Privacy Policy
*
Yes
Signature
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