Have-a-Go Form

Please fill in this Health & Safety Waiver prior to your Have-a-Go Session.

Have a Go Session Date (Please Select)

Booking Name (Individual, Business or School)

First Name

Last Name

Date of Birth

Gender

Phone Number

Address

Medical History. Please Specify

Emergency Contact NAME

Emergency Contact PHONE NUMBER

Date of Agreement

You will need to supply your personal information to the Grassroots Trust Velodrome in respect of this application. Your privacy is important to us. Your personal information is not shared with outside parties. The contact details you provide will only be used in relation to your use of the Grassroots Trust Velodrome and to send you relevant information. If you would like to update the information that you have provided, please send an email via the Grassroots Trust Velodrome’s website with the desired amendments. The Grassroots Trust Velodrome does not sell, trade, or otherwise transfer to outside parties your personally identifiable information. We may use non-identifying and aggregate information to better deliver our services. To prevent unauthorized access, maintain data accuracy and ensure the correct use of information, we have put in place appropriate physical, electronic and managerial procedures to safeguard and secure your personal information. Should you have questions or concerns about this privacy statement, please contact us via the Grassroots Trust Velodrome’s website. I also understand there are certain hazards, and risks involved with this activity which can cause personal injury and property damage. I further understand that the Grassroots Trust Velodrome does not assume responsibility for any such personal injury or property damage.

Parent Agreement (if under the age of 18)

Address

Your Booking Form and Waiver have been submitted. Thanks!

For all enquiries please contact reception:
Phone: 0800 VELODROME
or 07 823 1421
reception@velodrome.nz

Grassroots Trust Velodrome
15 Hanlin Rd
Cambridge 3283
Waikato
New Zealand

Home of Cycling is a New Zealand operated Charitable Trust
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FAQ

OPENING HOURS

Have-a-Go Form

Please fill in this Health & Safety Waiver prior to your Have-a-Go Session.

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