Send to: Development Dept.
Bristol Zoo Gardens,
Clifton,
Bristol
BS8 3HA
Runner’s details
ALL FIELDS IN BOLD MUST BE COMPLETED
First name
Address 1
Last name
Address 2
Email
City
Phone
County
D.O.B
Post Code
Wild Run – Jog for Giraffe 5k Entry
Entry Fees
Ticket Type
Children (aged 8 -14)
Adults
Standard
£16 £14.40
£18 £16.20
BZS Members
£14 £12.60
£16 £14.40
Start Time: 10.30am
Please tick to indicate your 11.00am
preferred start time* 11.30am
12.00pm
*Allocated start times are subject
12.30pm
to change dependant on interest.
01.00pm
Entry fee includes free day entry to Wild Place Project for the registered runner and three guests, a Wild Run medal and finishers
pack. Prices in red are for early bird entry and are valid for forms received before 01/06/2016.
I enclose remittance of my £_________________
Membership No. (if applicable)_______________________
Emergency Contact
First name
Last name
Phone
Do you have any medical history or conditions that we should be aware of? Yes
I have read and accept the disclaimer and the terms and conditions
□ / No □
(tick one box)
□ (tick box)
In doing so
I declare that I am medically fit to run and accept that Wild Place Project shall not be liable for any injury, illness or
loss of property as a result of taking part in Wild Run - Jog for Giraffe. I agree to declare in advance of the event, any
existing condition or medical history that the Organisers should be aware of. Entries are non-refundable.
Signature _____________________________________________ Date ____________________________
(an adult Parent/guardian must sign on behalf of any runner that is under the age of 18)
Name (if signing on behalf of an under 18) _____________________________________
Sponsored by
Bristol Clifton and West of England Zoological Society Limited Registered in England No. 5154176 Registered Charity No. 1104986