JB ACADEMY APPLICATION FORM.

Date…………………………..

Full NAME…………………………………………………………..Male/Female(tick)

Date of Birth………………………………….

Full Address………………………………………………………………………………………

Postcode……………….

Parents Guardians……………………………………………………………………

School

Details………………………………………

Qualifications………………………………

Nationality……………………………..Passport no…………………..Driving licence………. Y/N..

CYCLING INFORMATION.

Road..../Track…./Cyclo cross…/MTB… /BMX…/Gravel…/ Time Trial…./ (tick) Other….

Club

Information……………………………………………Sponsors…………………………………………

……….

BC Affiliated………….Region………………………Competition licence no…………………

Coach information……………………………………………………………………….(if any)

Riding Experience ………………….years……………UK………Abroad……….. (tick)

Palmares to date. ……………………………………………………………………………………………………

………………………………………………………………………………………………………………… (any type of event).

Personal Details

Medical conditions if any, with brief

details…………………………………………………………………………..

Height…………… Weight………….

Ambitions

Please briefly let us have your ideas and thoughts on why you would like to join the

Academy.

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Signed

…………………………………………………….. (applicant)

……………………………………………………...(Parent/Guardian)