Licence and Healthcheck Submission

Course: *

Submission: *

Full Legal Name: *

First

Middle

Last

Preferred Name: *

Email *

Email

Confirm Email

Double check your email for typos

I agree that, *

• I have checked that my licence is valid and not expired
• I am legally required to have my licence on my person and show it to my instructor each day of my course in order to able to participate

I agree that, *

• I have checked that both my licence, registration & insuranceare valid and not expired
• I am legally required to have both my licence, registration & insurance on my person and show it to my instructor each day of my course in order to able to participate

Upload: *

Click or drag files to this area to upload. You can upload up to 5 files.

If uploading your temporary license it must be accompanied with government issued picture ID such as a passport. An expired license will not be accepted.

Module: *

Module Date: *

Healthcheck: *

• No symptoms here, let's do this!
• I am aware that if I have mild symptoms (not covid) that I will be required to wear a mask within the trailer spaces.
• I am aware that if I am or become quite ill / have covid, I cannot attend out of respect for the health and safety of others as well as myself.
• I am not well and will not be attending

Additional Comments/Concerns:

Signature *

Submitting for the purpose of being able to attend the on-bike portion of my course

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