Group registration form for Bubble Rush 2015
PLEASE FILL IN CAPITAL LETTERS
Are you or anyone in your group taking part in memory of someone? Y
N
If so, would you/your group member be willing to tell us your/their story? Y
N
How did you hear about the event? ___________________________________________________________
Participant 1:
Name: _________________________________________ Date of birth:_________________
Address:__________________________________________________________________________________
_______________________________________________________________________Postcode:___________
Telephone: _____________________________
Email: ______________________________________________________
Emergency contact name (cannot be an event participant):__________________________________________
Emergency contact number: _________________________________
Do you have any medical conditions we should be aware of? Please state:
_________________________________________________________________________________________
T-shirt size for free Bubble Rush T shirt: S (35”/37”)
M (38”/40”)
L (41”/43”)
XL (44”/46”)
XXL
(47”/49”)
CHILDREN’S: age 5/6
7/8
9/11
12/13
14/15
Participant 2:
*Name: _________________________________________ *Date of birth:_________________
Please fill in your contact details if different to those of participant 1. Please ensure you fill out details
with an asterisk.
Address:__________________________________________________________________________________
_______________________________________________________________________Postcode:___________
Telephone: _____________________________
Email: ______________________________________________________
*Emergency contact name (cannot be an event participant):_______________________________________
*Emergency contact number: _________________________________
*Do you have any medical conditions we should be aware of? Please state:
_________________________________________________________________________________________
*T-shirt size for free Bubble Rush T shirt: S (35”/37”)
M (38”/40”)
L (41”/43”)
XL (44”/46”)
XXL
(47”/49”)
CHILDREN’S: age 5/6
7/8
9/11
12/13
14/15
Participant 3:
*Name: _________________________________________ *Date of birth:_________________
Please fill in your contact details if different to those of participant 1. Please ensure you fill out details
with an asterisk.
Address:__________________________________________________________________________________
_______________________________________________________________________Postcode:___________
Telephone: _____________________________
Email: ______________________________________________________
*Emergency contact name (cannot be an event participant): ________________________________________
*Emergency contact number: _________________________________
*Do you have any medical conditions we should be aware of? Please state:
_________________________________________________________________________________________
*T-shirt size for free Bubble Rush T shirt: S (35”/37”)
M (38”/40”)
L (41”/43”)
XL (44”/46”)
XXL (47”/49”)
CHILDREN’S: age 5/6
7/8
9/11
12/13
14/15
Participant 4:
*Name: _________________________________________ *Date of birth: ________________
Please fill in your contact details if different to those of participant 1. Please ensure you fill out details
with an asterisk.
Address:__________________________________________________________________________________
_______________________________________________________________________Postcode:___________
Telephone: _____________________________ Date of birth: ________________
Email: ______________________________________________________
*Emergency contact name (cannot be an event participant): ________________________________________
*Emergency contact number: _________________________________
*Do you have any medical conditions we should be aware of? Please state:
_________________________________________________________________________________________
*T-shirt size for free Bubble Rush T shirt: S (35”/37”)
M (38”/40”)
L (41”/43”)
XL (44”/46”)
XXL (47”/49”)
CHILDREN’S: age 5/6
7/8
9/11
12/13
Number of entries
Adult @ £20 pp
Child (under 16s)
@ £10
Total
14/15
Cost
£
Under 5s run for free
Be a ‘smart bubbler’!
This year, St Helena Hospice is celebrating 30 years of caring for local people, and events such as the Bubble
Rush ensure that we are able to continue our work. Why not become a ‘Smart Bubbler’? Simply raise and return
£100 sponsorship before Sunday 13th September, and we’ll say a big thank you by refunding your entry fee.
Terms and Conditions
1. These booking terms and conditions apply to everyone who takes part in Bubble Rush, and those who attend as spectators.
2. Places are limited on the Bubble Rush 2015 event and entries are processed in the order we receive them. The closing date
for entries is Monday 31st August 2015 at 11.59pm. All participants wishing to take part after this date will need to sign up and
pay on the day of the event.
3. All participants must complete and sign the entry form. They must pay the specified registration fee - £15 per adults and
£7.50 per child (under 5’s are free) in the early bird registration period, which will close on Friday 7th August 2015. From
Saturday 8th August 2015, registration is £20 per adult and £10 per child. Registration is non-refundable.
4. Bubble Rush 2015 is a St Helena Hospice event to raise money for St Helena Hospice. We ask that all sponsorship raised is
for St Helena Hospice, please do not raise money for other charities, trusts or funds.
5. All participants taking part in St Helena Hospice Bubble Rush do so at their own risk. In no event shall St Helena Hospice be
liable for any injuries, loss or damages whatsoever, including indirect, punitive, special, incidental or consequential losses
connected with any aspect of this event.
6. St Helena Hospice cannot be held liable for any changes made to the event for safety reasons, or as otherwise planned
through circumstances beyond their control. Nor can they accept any liability for any changes made to the venue or date of the
event.
7. St Helena Hospice reserves the right to alter the start time of the event at any time.
8. St Helena Hospice reserves the right to cancel this event at any time. In the event of this happening, entry fees and
sponsorship will be refunded in full.
9. All participants are responsible for their own medical condition. If in doubt about your ability to finish the Bubble Rush or you
have a medical condition that might affect your ability, consult your doctor prior to the event.
10. There is no minimum age for Bubble Rush however, anyone under the age of 16 must be accompanied by a registered
adult over the age of 18 at all times, and anyone under the age of 18 agrees that they have sought parent/guardian consent to
take part in this event.
11. School and youth groups who take part must have adequate supervision. Upon running through the Bubble Stations, all
children under the age of 16 must be accompanied by an adult who will be responsible for their safety. Small children may need
to be lifted through some parts of the bubble stations.
12. Disabled entrants are welcome to take part. However, due to the nature of the event, the location and some uneven terrain
through the grounds of Highwood’s Country Park, please contact St Helena Hospice prior to booking to establish whether the
event is suitable for you.
13. There will be no changing or bag drop facilities at the event, so you bring items along to Bubble Rush 2015 at your own risk.
14. The Smart Bubbler refund is available to everyone who raises and donates £100 or more in sponsorship by Sunday 13th
September 2015. Emails with information on how to claim your registration fee refund will be sent to participants and refunds
will be given to those who respond no later than Friday 2nd October 2015.
15. Please be advised that if you register any time from Friday 21st August you will not be guaranteed the size t-shirt that was
ordered. You will be given the nearest size possible to what was ordered.
16. T-shirts are only provided free of charge to registered participants. T-shirts will be available to collect from St Helena
Hospice’s fundraising office from Monday 17th August until Friday 28th August. After this time, t-shirts will be available to
collect on the day.
17. On no account are drugs or alcohol to be brought into the event site or consumed during the event. St Helena Hospice
reserves the right to refuse entry to anyone under the influence of drugs or alcohol.
18. Due to the nature of the dyes used in the bubbles, these may stain clothing. It is the participant’s responsibility to come
suitably dressed for the event. The event organisers take no responsibility for colour stains on any shoes or clothing.
19. The information you provide at registration will be shared only with St Helena Hospice, it will not be shared with any other
organisation.
20. Places are limited on the Bubble Rush event and entries are processed in the order we receive them. We will confirm you
have a place in writing.
21. Photos and videos will be taken during this event which may be used to publicise this event and the work of the charity
generally, by taking part, participants give their permission to be included in any material used.
22. No dogs permitted at the Bubble Rush event for participants; however, spectators are welcome to bring their dogs to the
event but are fully responsible for them.
23. We will confirm you have a place in writing.
24. I consent to St Helena Hospice contacting me via telephone, letter or email for any matter relating to my participation in this
event.
Conditions of entry: I have read and agree to the terms and conditions above and am signing on behalf of myself/the group.
I/the group understand that I/we take part in this event at my/our own risk and that St Helena Hospice will not be liable for any
injury or loss that may occur as a result of my/our participation. I confirm that I am/we are over 18 years of age and that my/our
parent/guardian has signed below if I am/we are not. I agree that medical advice should be sought from a General Practitioner
if I am/we are in any doubt as to my/our physical ability to participate in the event. I am/we are aware that my/our preferred
wave times and t-shirt sizes are not guaranteed. I am/we are aware that photographs and videos taken during the event may
be used to publicise the event and the work of the charity generally and give permission for this.
Signature (if you are filling out this form electronically please type your name to represent your confirmation):
___________________________________________ Date___________
Parent/guardian signature (if you or anyone in the group is under 18) (if you are filling out this form electronically
please type your name to represent your confirmation): _______________________________________
Date___________
Data protection: St Helena Hospice will not share your details with any other organisations. We would like to keep
in touch occasionally with news of our work and fundraising activities.
Do you consent to receive this information? Yes
No
c
c
c
c
We will send you an event pack once we have received your registration. T shirts will be available to
collect from the fundraising office (see above for address) from the 17th August.
Payment:
Payment method (please tick):
Cheque made payable to St Helena Hospice:
Debit/credit card:
c
By debit/credit card: To process your registrationcby credit card, we will need your three digit security number
from the back of your card. Please ensure you supply a correct contact number overleaf so that we can obtain
this from you when we process your payment.
Telephone number (if paying by card): _______________________________
Please debit: £________ from my Visa___ Mastercard___
My card details are as follows:
Name:_________________________________________
Card number: ___________________________________________
Valid from _ _/_ _ Expiry date _ _/_ _
3 digit security no. _ _ _
Please note your card details will be destroyed as soon as payment has been processed.
Please email the completed form to [email protected] or post to Bubble Rush, St Helena
Hospice, Fundraising Office, 1 The Atrium, Phoenix Square, Wyncolls Road, Colchester, CO4 9AS. You
will receive confirmation of your place and registration time once we receive your registration form.