MORE 16

On 9th March we are staging ‘MORE 16’ – an event aimed at reducing road collisions among 16 to 24 year olds – the most at-risk group. The event is being hosted at Millbrook Proving Ground and gives 16 year olds the opportunity to start their driving career in a safe environment.  Participants will have their first driving lesson and theory workshops to help keep them safe on the roads when they are legally old enough to drive. The sessions are from 0900 – 1245 or 1300 – 1645.

To take part in the course, you need to be 16 years old and live in either Central Bedfordshire or Luton Borough Council Local Authority areas.

The course is paid for by the two Local Authorities and is offered free of charge to people meeting the above criteria. Places are allocated on a first come first serve basis.                          If you are offered a place and then find that you cannot attend you must let me know at the earliest possible time and at the latest by 17.00 on Thursday 6th March. We reserve the right

to recover the costs for any cancelled place that we cannot subsequently fill and for any late cancellations. The charge will be £150.

We encourage parents/guardians to attend at the same time where they will be offered a high speed passenger ride around a Millbrook track by a professional, along with a parent’s workshop.

To apply please complete ALL sections of this form and return to: Michelle Watkins, Amey, Woodlands Annex, Manton Lane, Bedford, MK41 7NU.  Alternatively, you can scan and email them to roadsafety@amey.co.uk

MORE 16

Attendee:                                                                                                                                             

Date of Birth:                              _ Gender: (circle)            Male               Female

Address (incl. Postcode):                                                                                                                   

Telephone No:

Confirmation Email Address:

I confirm that I am 16 years old and live in Central Bedfordshire or Luton

(participant)_                                                                                                                                          

Where did you hear about the course?                                                                                           

My parent/guardian will/will not be attending with me (circle)

I confirm that is acceptable for my child (named above) to take part in MORE 16.  I am aware that graphic images of road collisions may be used in one presentation.

Signature of parent/guardian:                                                                                                             

Emergency Contact number:                                                                                                              

Name:                                                            Relationship to you:                                                      

Data Protection Act 1998

Personal contact details obtained via forms will be stored securely and will only be used for communication purposes. We will not distribute, sell, trade or rent your personal information to third parties.  Statistical data obtained from questionnaires will be collated and aggregate data will be used in any reported outputs. Such statistical data will not include personally identifying information.

RELEASE FORM

PHOTOGRAPHER:.................................................................................................

CHILDS NAME:.............................................

WHEN: on................................... (insert date)

WHERE: at................................................................................................ (location)

USAGE: For valuable consideration received I hereby grant Amey plc of The Sherard Building, Edmund Halley Road, Oxford OX4 4DQ (“Amey”), and Luton Borough Council, Town Hall, Luton LU1 2BQ and any of its licensees or assignees, the absolute right to use my photograph(s), including any other reproductions or adaptions, whether in physical form or held electronically or digitally, from the photographic shoot for the above mentioned photographic short, but only for the Amey brand and solely and exclusively for:

Magazines, Books, Calendars, Internet, Portfolios, Exhibition, Editorial, Advertising, or other use at Amey’s sole discretion.

AGREEMENT: I acknowledge by signing this form, and subject to restrictions stipulated and agreed, that I give up all claims of ownership, income, editorial control and use of the resulting photographs and assign all copyright ownership to Amey and Luton Borough Council and that no payment will be due. Use of the photographs may be granted to third parties, however the photographs will remain the property of Amey. I agree to hand over to Amey on demand any copies or negatives of the photographs (whether in physical form or held electronically or digitally) which are in my possession or under my control. I have read this form carefully and fully understand its meanings and implications.

I acknowledge that by signing this form I give Amey and Luton Borough Council full copyright and authority to publish my profile and photograph and agree with the terms listed above.

Signed (Parent/Guardian)................................................ date...........................

Print name

Signed on behalf of Amey UK plc

............................................................................    date...........................

Print name

Note: A child is a person under the age of 18 years.

MILLBROOK EVENTS INDEMNITY

I, the Parent/Guardian undersigned, hereby agree to the following conditions, which will allow the Child named below (hereinafter ‘The Child’) to use the facilities at Millbrook Proving Ground:

1.                  I shall be responsible for the consequences of The Child’s own conduct, and personal safety, including whilst driving or being driven, during the whole of today’s event.

2.                  The Child will agree to wear a seat belt properly fastened and to abide by the driving and safety requirements of Millbrook Proving Ground and the provisions of the Highway Code at all times whilst driving or being driven. I understand that unnecessary stops and deviations from the routes are not permitted.

3.                  The Child agrees to follow the indicated routes and obey all instructions from Millbrook marshals, staff and authorised representatives whilst driving. I understand that drivers who do not comply may be prevented from driving further at Millbrook Proving Ground.

4.                  Millbrook Events reserve the right to refuse an individual permission to drive their cars. All drivers and passengers are prohibited from consuming alcohol in the period leading up to and during driving such that it may make it unsafe to drive. In addition, drivers are prohibited from taking illegal drugs or medication, which may impair their ability to drive either before or during the event.

5.                  Except for injury or death due to negligence on their part, I indemnify Millbrook Proving Ground, their staff, agents and contractors against any loss or damage, however caused, sustained by me, my property, or The Child during today’s event.

DRIVE NAME:                                                                                                             

(PLEASE PRINT IN CAPITALS)

DATE:                                                                                                                                      

SIGNATURE OF PARENT or GUARDIAN: _                                                      

NAME:                                                                                                                           

(PLEASE PRINT IN CAPITALS)

DATE: