Application for a Guaranteed Place in a Running/Triathlon Event

WellChild’s Privacy and Data Protection Policy can be viewed here

* denotes required field.   * What are you applying for?  If you are doing a triathlon, which category ie. super sprint * Title  Mr Mrs Miss Ms Dr Rev Other  Other  * First name  * Last name  * Date of birth  (dd/mm/yy) * Email address  * Confirm email address  * Contact telephone number  * Address line 1  Address line 2  Address line 3  * City / Town  County  * Country  * Post code  * Please state your t-shirt size  Small Medium Large Extra Large * Occupation  * Employer  Medical/running experience * Do you have a medical condition  about which the organisers  should be informed?  Yes No If yes, please give details  * What is your level of running/triathlon experience (ie what triathlon/distances have you completed in the past?). Please give details:   * Are you a self-propelled wheelchair entrant? Yes No * Anticipated finish time  Running club (if applicable)    Sponsorship * Have you undertaken any similar  fundraising events in the past?    Yes No If yes, please give details * Bearing in mind any minimum targets we may have set, what are your fundraising expectations for this event?  * Please supply us with your ideas on how you would go about raising this amount. Will your employer match this amount or any part of it ? Yes No Unsure Team members (relay events only) Where did you hear about WellChild’s involvement in the event? WellChild Website WellChild News/eNewsletter Work Friend Gym Other (please specify) Other: Do you have a personal reason or story as to why you have chosen to support WellChild? Registration I would like a guaranteed place in the event and agree to raise the relevant minimum fundraising target for WellChild Yes No I agree that I participate entirely at my own risk and accept that WellChild are not liable for any loss, damage, claim, expense, injury or accidents which may arise as a consequence of my negligence at the event. I will abide the rules of the event and remain responsible for my own property.  I am in good health and will have done sufficient training to safely complete the course.  We would like to keep you informed of the activities of the charity that we feel may be of interest to you. Please tick if you do not wish to receive this.