The 4Louis Yorkshire 3 Peaks Challenge

Saturday, 28 June 2025, 06:00 - 23:59

The Important Bits

First Name *

Last Name *

Date Of Birth *

Mobile Number *

Would you like to be added to a What's App Group *

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Please describe and detail any medical condition you have and any precautions you need to adhere to or dietary requirements (if none, write none): *

If you are on or are required to take any medication please list the name of the medication you take, the required dosages and times it is needed to be taken (if none, write none): *

Please tell us your weight (important): *

Please tell us your height (important): *

T-Shirt Size (free) *

Please tell us your shoe size (important): *

My Address

Address Line One *

Address Line Two

Town/City *

County

Postcode *

Country *

Email *

Emergency Contact Details

Emergency Contact Name *

Emergency Contact Number *

Relationships to you? *

I/we agree to raise the minimum sponsorship amount of �250

I have read and understand the Terms & Conditions *

Please read and confirm you agree to the following from our event organiser Lost Earth Adventures.

1. You participate in the activities provided by Lost Earth Adventures at your own risk. If you feel any pain, dizziness or other problems you should inform your instructor immediately.

2. I understand that Lost Earth Adventures accepts no responsibility for loss, damage, or injury caused by participating in the activities provided by Lost Earth Adventures except where such loss, damage or injury occurred due to the negligence of Lost Earth Adventures.

3. I consent to receiving medical treatment that in the opinion of a qualified medical practitioner may be necessary.

4. I consent to undergoing First Aid treatment from a member of Lost Earth Adventures staff holding a First Aid Certificate if required.

5. I accept that there is an element of risk involved in the activities that Lost Earth Adventures provides.

6. By submitting this form you are hereby agreeing to the ʻTerms and Conditions of Courses Arranged by Lost Earth Adventures That Take Place in the United Kingdomʼ which is available to view on our website here: Terms and Conditions and confirm that you have read them. Please tick the box if you agree.

I have read and understand the Terms & Conditions *