Supporter Registration Form 

Please complete the form below if you would like to attend one of our cycling sessions.

If you prefer you can download the form here and please make sure you read our ground rules before you complete the form.

  • Who are you supporting?

    Please give your full name and relationship to cyclist.
  • Name & address of centre / organisation arranging your attendance:(Centre must be registered with Wheels for Wellbeing)
  • Supporter information

  • Emergency Contact

  • (must be signed before your Cyclist(s) can cycle with us)
    I have read and agreed to Wheels for Wellbeing’s Ground RulesAndGuidelines for Carers and Support WorkersI confirm that I have a consent of my emergency contact to share his/hers personal details.