Leicestershire 3 Peaks Challenge Entry form & disclaimer

    (To be completed by all challengers/to be completed on behalf of children & young people by parent/carer)





    Email is the most efficient and cost-effective way for us to send out updates & information to you on the run-up to the challenge. We would also like to send you our monthly e-newsletter where information on the event and how the funds raised will make a difference will be included. Please tick here if you do not wish to receive this. You can unsubscribe at anytime.

    If completing form on behalf of a child (under 18), please give your details.



    Entry type purchased

    Completing form as part of team/family?



    *This information allows us to add you to the relevant team/family.

    Fundraising Information

    I have read and understand the fundraising pledge. Also found in the event pack.

    Parking Information

    I have read and understand the parking details. Also found in the event pack.

    Medical Disclaimer

    All participants must read the information below. On submitting this form you accept full responsibility for any injury, accident etc., which may result from their participation in the following event.

    “I confirm that I am familiar with the nature of the activity which I wish to undertake and acknowledge all the risks involved. I hereby declare that I am in good health, and that I am not suffering from any medical condition or disability that might make it unsafe for me to take part in the event. I accept that I shall be solely responsible for any decision as to my fitness to participate and to complete the challenge. If there are any changes to the above prior to the challenge I will make the event organisers aware. I understand that I am taking part in an event which will require me to undertake exercise for a prolonged period. I will have, if necessary, gained advice from my GP as to whether I am physically prepared to undertake the challenge. I also understand that I will only undertake the challenge if I feel that I am physically able to do so.”

    Parents/Guardians of participants under the age of 18

    I, having read the terms and conditions of this application, on submitting this form provide approval and undertake acceptance of the above.

    Medical Conditions

    Give details of all medical conditions, including allergies, current conditions (such as diabetes, asthma or epilepsy), and any conditions of the heart or current injuries that you may have. This information will be kept by our support team and accessed on the day if required.

    Emergency Contact Details

    In case of illness/emergency on the day please provide us with emergency contact details.




    Runners

    If you intend to run this event, please give a rough estimate as to how long you will take.

    Medals

    We plan to give eco-friendly medals this year. To help with numbers, please confirm if you’d like a medal at the finish line.

    Do you plan to bring a four-legged friend with you?

    How did you hear about this event?

    Once we have your entry fee and completed registration and disclaimer form we will confirm your place and will then keep in touch with all the information you need on the run up to the Challenge. Registration fees are non-refundable.

    If you have any questions please email rachel.markham@charity-link.org or call 0116 222 2218.

    If any of the above details change in between completing the form and the challenge itself, please notify us. All information provided will be used only for the purpose of this challenge and will be destroyed after the event. Challengers will not be able to participate in the event unless we have a completed form.

    Please note that photos will be taken on the day and may be used for promotional use. If you have any concerns about this make us aware. Thank you

    We look forward to welcoming you to the team!