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5K OB
Saturday 18th March 2017
Race Starts at 12 noon
Knebworth Park, Stevenage SG1 2AX
Sign up online at www.ghhospicecare.org.uk
or call 01462 679 540
supported by
Registered Charity No. 295257
Muddy m
Mayhe
3 SIMPLE WAYS TO ENTER
1.
Online at www.ghhospicecare.org.uk
2.
Over the phone 01462 679540
3.
Post this form back to: Garden House Hospice Care,
Gillison Close, Letchworth Garden City, SG6 1QU
Please note - all participants must complete a registration form
Your details
Terms & Conditions of Entry
Name:
•It is acknowledged that participation in the Event will be
physically demanding and each participant is aware of the
nature of the Event and associated medical and physical risks
involved.
•Each participant agrees that he/she is physically capable of
competing in the Event and agrees to be solely responsible
for his/ her actions and the Event Organiser, its officers,
employees, agents, affiliates, associated companies, sponsors
or medical advisers are not responsible for any injury or
illness that the participant may suffer as a result of his/
her participation in the Event (unless caused due to the
negligence of the Event Organiser). The participant accepts
that should any medical or physical condition arise prior to or
on the day of the Event which is likely to affect his/her ability
to compete; the Participant will withdraw in accordance with
these Conditions; this also includes high temperature; feeling
unwell; any participant deemed to be under the influence of
alcohol or other substances.
•Medical advice should be sought from a General Practitioner
if a participant is in any doubt about his/her ability to take
part in the Event or has any underlying medical condition-for
example uncontrolled high blood pressure; Heart Condition;
Pregnant.
•Official Event Organisers have the authority to remove a
participant from the Event if judged to be physically incapable
of continuing the event without risk of serious injury
•Minimum age for participants is 14 years. Under 18 years
must be accompanied by a participating adult at all times
during the event.
•Participant must adhere to all directions and instructions
from our official event organisers.
•Suitable clothing must be worn at all times.
•Any non-sportsman-like conduct constitutes grounds for
immediate disqualification.
•Entry Fee-Once registered, is non refundable.
•By registering for this event you are agreeing that any official
photographs and video taken, can be used in the promotion
of this and future GHHC events.
Address:
Postcode:
Email:
Contact No.:
D.O.B.:
Please note that under 18’s must be accompanied by a participating adult.
Team Name
Entry Fee
Amount
Adults (18+ years) £20 each
Children (14-17 years) £12 each
I would like to purchase
a Muddy Mayhem Event
T-shirt £10 each Please tell
us the size and quantity of t-shirt
you will require on the day.
S
M
L
XL
Total Payment
r Cheque: I enclose a cheque for £
made payable to Garden House Hospice Care
r Credit/Debit Card: I authorise payment of £
Card No:
Expiry Date:
Security Code:
Signed:
Date:
I am signing on behalf of:
Any participants under the age of 18 must have form signed by
an adult over 18 years old
By signing this registration form I confirm that I have read, understood and
accept the terms and conditions for the Muddy Mayhem 5k obstacle course.
Data Protection Act: Garden House Hospice Care values your
support and promises to respect your privacy. By providing
your details we will be able to provide the requested services
(and details of future relevant events) and maintain our
records. Unless you tick the box below to opt in, we will be
unable to contact you from time to time about future Hospice
fundraising news, activities and appeals.
I wish to be contacted by: (tick box)
r Email
r Telephone r Mail
r Text/SMS
•We will not disclose or share our personal information for
marketing purposes with any third party organisation. For
more details about the way we use your information, our
privacy policy is on our website www.ghhospicecare.org.uk