MX Training Day Brian Jorgensen MX School

Brian Jorgensen MX School

Training days, coaching and race season preparation
Rider Information
Rider's Name*

First NameLast Name
Birth Date*

MonthDayYear
Bike size / cc*
eg 85 / 125 / 250
Beginner (must have been riding for over 12 months to attend)IntermediateAdvanced / RacingPro Level Racing eg European
MaleFemale
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Information (if rider is under 18)
Name

First NameLast Name
Telephone number
E-mail*
example@example.com
Emergency Information
Emergency Contact's Name

First NameLast Name
Relationship
Telephone number
Does the athlete have any injuries, chronic illness, or medical conditions? If yes, please describe.
Agreed
Informed Consent and Acknowledgement

I hereby give my approval for myself / my child’s participation in any and all activities prepared by Brian Jorgensen MX School during the selected training day. I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Brian Jorgensen MX School and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected training sessions.

In case of injury to myself or said child, I hereby waive all claims against Brian Jorgensen MX School including all coaches and affiliates, all participants, sponsoring agencies, advertisers, and owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all motorsport activities. Some of these injuries include, but are not limited to, the risk of fractures, paralysis, or death.
Medical Release and Authorization

Permission is granted to Brian Jorgensen MX School and its affiliates including Directors, Coaches, and Team Parents to provide any required emergency treatment prior to the child’s admission to any medical facility.

This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances.
Cancellations

Cancellations can be made if the rider sustains an injury before the school begins and is not able to participate. The rider will be able to reschedule for another training school or training days equivalent to the same monetary value within a 12 month period from the starting date of the enrolled MX School. Refunds are not possible. You should ensure that you have adequate insurance to cover your trip or any cancellations.
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

Services / Payment*

(FULL PAYMENT) - MX Training Day - May 27th 2025 - Shrewsbury SY5 9

*Includes 1 rider place on training day. Track fee is paid on arrival at £40 cash.

£100.00

DEPOSIT PAYMENT - (remainder payable at the track ) MX Training Day - May 27th 2025 - Shrewsbury SY5 9

Deposit payment to secure 1 place on training day - non refundable. Further payment of £50 for training and £40 for track fee is payable on arrival.

£50.00 Quantity

Follow on training program - 1 month personal coaching - introduction to higher level training (on and off the track)

MX drills, Physical Training, habit building, personalised assistance and program planning.

£150.00

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Total

£0.00

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Brian Jorgensen MX School

Rider Information