Peterborough Sleep Out Registration Form

Peterborough Sleep Out Registration Form

Sleep out for the night in a cardboard box to help raise money to create an all inclusive Community Hub in Bretton
Participant Name*

First NameLast Name
Participant Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Partcipant Email Address*
example@example.com
Partcipant Phone Number*
Participant Date of Birth*

MonthDayYear
Date
CHILDREN MUST BE AGED 8 AND OVER AND MUST BE ACCOMPANIED BY THEIR PARENT OR DESIGNATED GUARDIAN FOR THIS EVENT. PLEASE TICK BELOW TO CONFIRM YOU UNDERSTAND THIS AND AGREE
I understand and agree to the statement above that: CHILDREN MUST BE AGED 8 AND OVER AND MUST BE ACCOMPANIED BY THEIR PARENT OR DESIGNATED GUARDIAN FOR THIS EVENT.*

I agree and understand
By taking part in this event you are agreeing to attempt to raise funds for the new YMCA Bretton Community Hub. Even if you only feel able to raise £5 - every penny counts! Please let us know below what your personal/team fundraising target is.*
Are you taking part as an individual or as part of a team? Please note that if you are part of a team, each team member will need to fill in their own registration form.*

IndividualTeam
How many people do you expect will be in your team? Please note that each team member will need to fill in their own registration form. (If you are not part of a team just type 1)*
If you are taking part on behalf of your workplace/organisation please let us know which one - please type individual if not from either of these.*
How did you hear about the event?*
Emergency Contact Information
Name*

First NameLast Name
Relationship*
Contact Phone Number*
By submitting this registration form you are agreeing to obtain sponsorship solly for the cause 'YMCA Bretton Community Hub'.

You are agreeing that this is the only fundraising that you will be undertaking by being a aprt of this event.
Do you suffer from any of the following:
Chest pains*

YesNo
High or low blood pressure*

YesNo
Epilepsy*

YesNo
Diabetes*

YesNo
Asthma/Bronchitis*

YesNo
Back problems*

YesNo
Bone/Joint injuries*

YesNo
Fainting*

YesNo
Have you undergone major surgery?*

YesNo
Is there anything else we should know?*

YesNo
If you have answered yes to any of the above question please provide details below or type NA if you answered No to all questions.*
CLICK HERE TO READ OUR DATA USE TERMS AND CONDITIONS
Please indicate if we can keep in contact with you to advise of future fundraising events and YMCA news. We will never sell or pass on your details to any third party.*

YesNo
Participant Waiver
I declare that the above information is correct to the best of my knowledge. I know of no reason why I should not take part in physical activity.

If this registration form is for your child or any other child that is accompanying you, please complete your own details in the waiver section.

By doing so, you are declaring that you accept full responsibility for the child's wellbeing and safety during this Sleep Out event.

Please use your mouse or other device to sign the declaration below.
Name

First NameLast Name
Signature

Clear
Date

MonthDayYear
Date
Registered Company No: 3561613
Registered Charity No: 1069810
NROSH No: H4179
Should be Empty:

Peterborough Sleep Out Registration Form

Emergency Contact Information

Do you suffer from any of the following:

Participant Waiver