Inclusive Bike Hire Scheme

Inclusive Bike Hire Scheme
Inclusive Cycle will be delivered in partnership with Disability Sport NI.

Please note, once you have submitted the information below, you will then be contacted by a member of staff to confirm availability.

All participants must be accompanied by a parent/carer throughout the duration of their hire.
Section 1

Applicant Information (Participant Information)
Name *

First Name Last Name
Gender *
Please select option via drop - down menu
Date of Birth *

Day Month Year
Insert Date
Age *
Address *

Address Line 1

Address Line 2

Town County

Post Code
Contact Number

+44 Number
Email *
Do you consider yourself to have a disability? *
If yes, please specify the nature of the disability.
Section 2

Parent / carer accompanying participant
Contact name *

First Name Last Name
Emergency Contact Number *

+44 Number
Section 3

Information on all bike/trike are provided on the website.
What bike/trike are you requesting to hire?
Do you require hire of a helmet?
What location would you like to hire the above bike/trike?
Please indicate the date and time you would like to hire the adult hand cycle
Hire agreement

I agree to adhere to the following:-
- 48 hour hire notice must be provided to allow the appropriate cleaning/booking process.
- In the event of adverse weather conditions, adapted bikes/trike can not be hired out.
- You understand that while using any hire bike/trike, injuries may occur for which the council is not directly responsible.
- Hire bikes/trikes are not permitted outside of leisure centre running track.
- Cycling helmets must be worn at all times.
Section 5

Privacy Notice / Data Protection
Sport Northern Ireland Every Body Active 2020 (EBA 2020) Privacy Notice

I agree to and confirm the following;

> The information provided within this form is accurate and correct;

> The information provided in this form will be shared with our programme partners in the area you reside (i.e. Fermanagh and Omagh District Council);

> The information will be used for the research and analysis of participation figures in Council (Fermanagh and Omagh District Council) organised sport and activity sessions i.e. summer multi - sports skills camps / programmes as part of the EBA 2020 programme;

> Sport Northern Ireland (SNI) as the the Data Controller will retain this information in line with their retention and disposal policy;

> Fermanagh and Omagh District Council will retain this information for one year following the end of the EBA 2020 programme.

Fermanagh and Omagh District Council Data Protection

In accordance with the Data Protection Act 2018, Fermanagh and Omagh District Council has a duty to protect information we hold on you.

For further guidance on how we hold your information please visit the Privacy Section on the Council website, https://www.fermanaghomagh.com/your-council/privacy-statement
Section 6

Photography / Filming Permission
Please indicate below (by selecting 'yes' or 'no') whether permission is authorised in relation to the participant outlined above (Section 1) to be photographed and / or filmed whilst participating in activities associated with the Every Body Active 2020 programme.
Permission authorised re. photography and / or filming (yes or no) *
Please select 'yes or no' via drop - down menu
Section 7

Fermanagh and Omagh District Council / Sport Northern Ireland would like to contact you for the following reasons;
Please select options below, if you provide permission for Fermanagh and Omagh District Council / Sport Northern Ireland to contact you for the following reasons;

To take participate in EBA 2020 surveys with the aim of improving services To offer tailored activities / classes based on your analysed data To offer incentive schemes for EBA 2020 participation To offer the opportunity to participate in programme focus groups providing feedback on the programme with the aim of improving future services programmes for your community
There are limited numbers of adapted bikes/trike available and will be allocated on a first come, first served basis. Applicants will be sent further information in due course to confirm hire requests

Further contact will be made in order to complete a Covid 19 questionnaire, mandatory by Disability Sport NI.

** This form must be completed by a parent / guardian **
Should be Empty:

Section 1

Section 2

Section 3

Section 5

Section 6

Section 7