RRC Couch to 5K - Registration Form (April 2025)

Ruislip Running Club

Couch to 5K Registration Form (April 2025 to June 2025)
Everyone in RRC wants you to succeed in your running and we know how hard it can be. So we promise to support you every step of the way, we just ask that you meet us half way and promise to reach out to us when you can't run, talk to us if it feels too much and commit to working with us by staying with us for just 10 weeks, even if you miss the odd evening. It'll be worth it, we promise.
Participants Information
Full Name*

First NameLast Name
Date of Birth*

DayMonthYear
Address*

Street Address

Street Address Line 2

CityCounty

Post CodeCountry
E-mail*
Mobile Number*

Area CodePhone Number
Participants Information - Emergency Contact
Emergency Contact*

First NameLast Name
Relationship to you?*
Mobile Number*

Area CodePhone Number
Phone Number*

Area CodePhone Number
Participants Information - Health Questionnaire (Par-Q)
Common sense is your best guide when you answer this questionnaire. Please read the questions carefully and answer each one honestly: check YES or NO.

You should always consult your doctor before starting a new fitness activity.

Par-Q*

	Yes	No
Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?
Do you feel pain in your chest when you do physical activity?
In the past month, have you had chest pain when you were not doing physical activity?
Do you lose balance because of dizziness or do you ever lose consciousness?
Do you have bone or joint problem (for example, back, knee, or hip) that could worsen by a change in your physical activity?
Is your doctor currently prescribing drugs (for example water pills) for your blood pressure or heart condition?
Do you know of any other reason why you should not do physical activity?
Is there any family history of heart disease, stroke, raised cholesterol or high blood pressure?
Do you suffer from diabetes, epilepsy or asthma?
Do you have, or had any illnesses recently we should be aware of?
Are you pregnant, or have you given birth in the last six weeks?
Have you recently has surgery?

Please provide further details, if you have answered Yes to any of the questions above
What is keeping you from achieving your Running goals? (Tick all that apply)*

Lack of motivationTimeNot knowing where/ how to beginSelf consciousMoneyLack of resultsHitting a plateauOther
What motivates you? (Tick all that apply)*

Seeing resultsHaving funPraise/ rewardsAccoutabilityFeeling betterConnecting with othersOther
What's your current activity level?? (Tick all that apply)*

NoneLittle (Less than an hour a week)Moderate (1-5 hours a week)High ( Over 5 hours a week)
Do you smoke including vape?*
Do you consume alcohol?*
Participants Information - Terms & Conditions
General T's & C's

1) Members must be 18 or older.

2) You agree to comply with the Rules of Membership, which are availble via our website. This refers to use of facilities and your conduct. We may make reasonable changes to these Rules at any time provided that we give you advance notice of the change.

3) We will not be liable or responsible for any failure to perform, or delay in performance of, any of our obligations under these terms that is caused by any event that is outside of our reasonable control.

4) This agreement is governed by English Law.

5) We may terminate this agreement with immediate effect on notifying you, if you are in breach of the Clubs Rules.

6) We will use the personal information you provide to us to:
(a) provide your membership services;
(b) process your membership payment; and
(c) inform you about similar products or services that we provide, but you may stop receiving these at any time by contacting us.

7) We will not give your personal data to any third party.

8) We may communicate health and fitness related information to you by email or SMS.

9) You agree to tell us immediately of any changes to your personal details including contact information.
Participants Information - Fees & Payment Information
1) Cound to 5K participants are required to pay a £10.00 non-refundable booking fee. Upon completion of the programme, if you choose to become an official Ruislip Running Club member, this fee will go towards your yearly membership fees. In order to become an RRC member you will be required to pay an additional £35.00 for the membership fees (normal membership fee is £45.00). Please note, the membership year runs in-line with England Athletics memberships from 1 April to 31 March.

2) The £10.00 non-refundable booking fee is due IMMEDIATELY upon registration. There are limited spaces on the programme, any delay in payment may result in a loss of placement on the programme.

3) The £10.00 non-refundable booking fee shall be paid via bank transfer using the below bank details.

Natwest

Payee: Ruislip Running Club

Account: 1518 6237

Sort: 60-18-05

Reference: Your First Initial and Surname (i.e. MSmith)

Note: All payments must be made via online bank transfer. You will receive a message confirming receipt of payment.
Participants Information - Termination
All cancellation notices must be sent in writting to membership@ruislip-rc.org.uk. Booking fees are non-refundable.
Participants Information - Privacy Policy
If full membership is sought, it is important to know that the membership process is in coordination by the Ruislip Running Club but processed through England Athletics, and it is not an automated system. This means that we will need to pass your details to England Athletics to complete your membership.
I am aware and accept that the data I provide will be passed to the Athletics Governing Bodies and will be processed in accordance with the Clubs Privacy Statement.*

I accept
Ruislip Running Club will use the information you provide on this to be in touch with you and to provide updates including marketing via Email and Telephone which includes SMS and Whatsapp.

Photos taken during the Couch to 5km training may be used for promotional purposes on public and social media platforms.
You can change your mind (cancel your participation) at any time by contacting us at membership@ruislip-rc.org.uk.
Participants Information - Confirmation
I have read, understood and completed this questionnaire to the best of my knowledge. By signing this agreement, I accept the terms set out by Ruislip Running Club.
Signature*

Clear
Participants Information - Signature
Date

JourMoisAnnéehi me messaoudMinutesAM/PM Option
Should be Empty:

Ruislip Running Club

Participants Information

Participants Information - Emergency Contact

Participants Information - Health Questionnaire (Par-Q)

Participants Information - Terms & Conditions

Participants Information - Fees & Payment Information

Participants Information - Termination

Participants Information - Privacy Policy

Participants Information - Confirmation

Participants Information - Signature