Sponsored Walk - Disclaimer | Neighbours in Poplar

Neighbours in Poplar

Sponsored Run - Disclaimer Form

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

About You

First Name

Last Name

Address

Postcode

Phone

Please list any Medical Conditions/ Injuries

Emergency Contact

First Name

Relationship to you

Last Name

Emergency Contact Number

Run / Walk Waiver

I declare that I am over the age of 16 years and medically fit to participate in a 5K run. I understand that by choosing to run the Neighbours in Poplar's event on the 26th June 2021 at 11am, I do so entirely at my own risk.

Please tick the box if you have read and agree to the terms and waiver above

Your Signature

Date

Thanks for submitting! Remember to download your Sponsorship Forms. Good Luck!

Neighbours in Poplar

Sponsored Run - Disclaimer Form

About You

Emergency Contact

Run / Walk Waiver

Working in Partnership with

Recognised and Awarded with