Couch to 5k Running Group | Bournemouth Bay Run 5k

Registration Information

Some of the below questions are to help the Forest Holme Hospice Charity fill out your Bournemouth Bay Run Registration.

Your Details

First Name *

Last Name *

Gender: *

Date Of Birth *

Medical Condition *

Yes No

Are you planning to participate in the event using a handbike or wheelchair *

Yes No

Are you a UKA member *

Yes No

Your Contact Details

Email *

Phone Number *

Would you like to be added to the Forest Holme Whatsapp Group? *

Yes No

We will only add you to the groups for the period of the 10 week couch to 5k programme. However, please feel free to leave the group whenever you want, there is no obligation to stay.

My Address

Address Line One *

Address Line Two

Town/City *

County

Postcode *

Country *

Next of Kin Details

Full Name *

Contact Number *

Relation to you *

Other Information

Please select your t-shirt size *

Discalimer

am fully aware of the risks associated with physical activity. I am in good medical condition/health and am sufficiently fit to participate in the Forest Holme Hospice Charity Couch to 5k running group programme. I have no medical condition which would prevent me from safely participating in this activity; and I have medical clearance to participate. I knowingly and willingly assume all such risks and acknowledge that my participation in this activity is fully voluntary. I understand that no liability, loss, damage or costs are held by Forest Holme Hospice Charity and any organisations or individuals arranged by them, in the running of this programme. This includes injury, death, property loss or damage. I have read this form and fully understand that by signing this declaration I am agreeing to abide by all program guidelines.

I have read and understand the Terms & Conditions *

Terms & Conditions

By registering to take part in the Forest Holme Hospice Charity Couch to 5k running group, you agree with Forest Holme Hospice Charity that: Registration and participation You agree to comply with the rules and regulations set out by Forest Holme Hospice Charity. You are over 18 years of age (or 16 - 17 years of age with parental consent) Contact details provided are used to keep you up to date about the event. Publicity By taking part in the event, you understand and accept that photos or videos may be taken, which may be used for publicity purposes. Liability You understand that you have entered the event at your own risk, no liability is held by the charity or charity partners. Data Protection You agree that the personal information provided by you, may be shared with the event organiser, who may use it in connection with the organisation and administration of the event. Fundraising Entry into this event is �23.00 and payable direct to Forest Holme Hospice Charity. You agree to raise a minimum amount of �50.00.

I have read and understand the Terms & Conditions *

Donations

Choose an amount:

�5

�10

�20

Other (�)

No Donation

Gift Aid Declaration:

* I am a UK taxpayer and understand that if I pay less Income Tax and/or Capital Gains Tax in the current tax year than the amount of Gift Aid claimed on all my donations it is my responsibility to pay any difference.