5 Mile Road Race
& Family Fun Runs
Sunday 4th June 2017
Chippenham Rugby Club
Fun Runs start from 10:00am/ 5 Mile Race 11:00am
(Please Note: On-day registration closes promptly at 9:45 for Fun Runs and 10:30 for 5 Mile Road Race)
Entry Fee: £9 affiliated club members/ £11 unaffiliated members
(£2 extra on the day)
All Fun Run Entries £4
£50 cash prize for 1st male and 1st female (5 mile race)
Medal to all finishers
Scenic and accurately measured 5 mile loop towards Biddestone Village
ARC Rules Apply—ARC 13/007
Toilets, car parking and refreshments available
www.chippenhamharriers.co.uk
Official Use only
Chippenham 5 Mile and Fun Run Entry Form
On-line entry also available at www.entrycentral.com/Chippenham5
Closing Date for Pre-Entries: 1st June 2017
Please complete a separate form per entrant, numbers to be collected on race day. Please make cheques payable to
‘Chippenham Harriers’
Entries to: The Entries Secretary, Summerfield House, Hungerdown Lane, Chippenham, Wiltshire, SN14 0JR
I WISH TO ENTER (PLEASE CIRCLE)
5 Mile Race
Under 5/ U7 Fun Run
(15 years and over only)
(approx ½ mile)
SURNAME
FORENAMES
ADDRESS
TELEPHONE
EMAIL
DATE OF BIRTH
AGE ON RACE DAY
GENDER
CLUB OR UNATTACHED
SIGNATURE
Male
Under 9/ U11/ U13/
U15/U17
Fun Run
(approx 1 mile)
Female
Declaration: I declare that I (my child) shall abide by the rules of the race. I will follow all instructions given by race
officials. I accept the organisers shall not be liable for damage, action, claim, costs or expenses, which may arise as a
consequence of my participation in this event. I declare that I will not compete in this race unless I am in good health
on the day of the race and that in any case I will compete at my own risk. Parent or Guardian signature is required
for entrants under 16 years of age.
Important Notes:
On-day entries must be made before advertised closing times, no exceptions will be made – Please arrive early to
avoid disappointment.
All runners must wear an issued number.
Recommended minimum age for Fun Run is 3 years, race category is by age of child on day of race.
Course is unsuitable for prams and wheelchairs.
Pedestrian access only to Rugby Club between 10:50 and 12:15 for safety all participants. No vehicle entry/exit
between these times.
No parking along the A350 allowed.