To be completed on behalf of applicants under the age of 18

I understand the Requirements and Conditions of entry for the Haltwhistle Challenge and give permission for the young person entered above to participate in the company of the below-mentioned adult entrant.

Date of entry

ALL APPLICANTS

Please check one box

Please tell us who paid for your booking.

Enter “self” if it was you.

(This information enables us to match up the payments with the entry forms where multiple entries are paid for by one person.)

DATA PROTECTION ACT:

Entrants’ details will be held temporarily in an electronic retrieval system, to be used only for the purpose of administering the event.  If you are willing for us to contact you electronically with details of our future walking festivals and challenge events, please check the box  

FIRST NAME (as you would like to see it on certificate)

SURNAME (as you would like to see it on certificate)

WALK ER

RUNNER

ADDRESS FIRST LINE

ADDRESS SECOND LINE

TOWN/CITY

COUNTY

POSTCODE

VEHICLE REGISTRATION NUMBER (if available)

HOME TELEPHONE NUMBER

MOBILE PHONE (in case of emergency during event)

EMAIL ADDRESS

CONFIRM EMAIL

EMERGENCY CONTACT NAME

PHONE NO FOR EMERGENCY CONTACT

I agree to follow the Requirements and Conditions of the Haltwhistle Challenge and accept the organisers’ decisions as final.  I fully understand that I enter at my own risk and that landowners, tenants and the organisers are in no way responsible for any illness or injury to me or anyone in my charge nor for any property lost, stolen or damaged during or after the event.

Please check the box if you agree

NAME OF PARENT/GUARDIAN

NAME OF ACCOMPANYING RESPONSIBLE ADULT