Sponsored Walk - Registration | Neighbours in Poplar

Neighbours in Poplar

Sponsored Run - Registration Form

Saturday 26th June 2021 at 11am Victoria Park – Venue may change due to COVID

About You

First Name

Last Name

Address

Postcode

Phone

DOB

T-Shirt Size

Do you have any health problems we should be aware of?

Emergency Contact Name

Emergency Contact Number

Disclaimer

I agree that I will follow all safety guidelines on the day and participate in the Neighbours in Poplar Sponsored Walk at my own risk.

If under 16:

I, parent/guardian of participant give permission for my child to participate in the sponsored walk and have arranged adult supervision for my child

Your Signature

Date

Payment Details

Registration is just £7 per person. This helps towards the cost of the administration and the T-Shirt

I plan to raise

Please make all cheques payable to Neighbours in Poplar

Bank: Barclays

Acct Name: Neighbours in Poplar

Sort Code: 20-53-04

Acct No: 00595551

Reference: Sponsored Run

Children under 16 are FREE to register (this doesn't include a t-shirt), a registration form MUST be completed.

Thanks for submitting! Remember to also complete the Disclaimer Form

Neighbours in Poplar

Sponsored Run - Registration Form

About You

Disclaimer

If under 16:

Payment Details

Registration is just £7 per person. This helps towards the cost of the administration and the T-Shirt

Please make all cheques payable to Neighbours in Poplar

Bank: Barclays

Acct Name: Neighbours in Poplar

Sort Code: 20-53-04

Acct No: 00595551

Reference: Sponsored Run

Children under 16 are FREE to register (this doesn't include a t-shirt), a registration form MUST be completed.

Working in Partnership with

Recognised and Awarded with

Neighbours in Poplar

Sponsored Run - Registration Form

About You

Disclaimer

If under 16:

Payment Details

Registration is just £7 per person. This helps towards the cost of the administration and the T-Shirt

Please make all cheques payable to Neighbours in Poplar

​

Bank: Barclays

Acct Name: Neighbours in Poplar

Sort Code: 20-53-04

Acct No: 00595551

Reference: Sponsored Run

​

Children under 16 are FREE to register (this doesn't include a t-shirt), a registration form MUST be completed.

Working in Partnership with

Recognised and Awarded with