PWRBRYD 6TH AND 7TH OF JUNE 🏋️♂️🤸♀️
Please provide your challenge selection, contact details, emergency contacts, and medical information.
LEAD BOOKER
*
First Name
Last Name
£50 per pair.
All proceeds from the ticket sales go straight back into the Maternity Bereavement Appeal. Thank you for your support.
Joleigh_6@hotmail.com
*
example@example.com
Telephone number
*
PWRBRYD
Please select below which day and event you will be entering.
Saturday 6th of June?
Scaled
RX Female
Mixed Scaled Pairs
Sunday 7th of June?
Scaled
RX Male
Mixed RX Pairs
CONTESTANT 1
Each contestant needs to complete all the required information below.
Contestant 1
*
First Name
Last Name
DOB:
Gender
*
Email
*
Contact telephone number
*
Emergency Contact Name
*
Emergency Contact Relationship
*
Medical Information
Do you have any allergies?
*
No
Yes (please specify below)
If yes, please specify your allergies
Do you have any chronic medical conditions (e.g., asthma, diabetes, heart conditions)?
*
No
Yes (please specify below)
If yes, please specify your medical conditions
Are you currently taking any medications?
*
No
Yes (please specify below)
If yes, please list your medications
Do you have any physical restrictions or injuries that may affect your participation?
*
No
Yes (please specify below)
If yes, please describe your restrictions or injuries
Contestant 2
*
First Name
Last Name
DOB:
Gender
*
Email
*
Contact telephone number
*
Emergency Contact Name
*
Emergency Contact Name
*
Emergency Contact Relationship
*
Medical Information
Do you have any allergies?
*
No
Yes (please specify below)
If yes, please specify your allergies
Do you have any physical restrictions or injuries that may affect your participation?
*
No
Yes (please specify below)
If yes, please specify your medical conditions
Do you opt in to having the charity contact you regarding any further events or information regarding the CHFT Charity
Email
Telephone
Letter
I give permission for CHFT charity to
Type option 1
Type option 2
Type option 3
Type option 4
My Products
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TEAM PAYMENT
£
50.00
Quantity
1
2
3
4
5
6
7
8
9
10
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Register
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