2019 Fun Run Entry

If this is an entry for a school pupil, be aware that their school may be submitting a 'team' entry later. They only have to enter once, make sure the school is aware they have entered and paid

Inputs marked ** are really important to us

Runner First Name: **

Runner Last Name: **

Gender:SELECT Female Male **

EITHER
Date of birth:    **
OR
Age on 12/5/19    **

For young runners these are details of parent / guardian otherwise they are the runner's details contact E-mail: **

contact Number:

Address:


Next of kin
Name and contact:
** Reminder- runners under 18 should be accompanied at the event
Reminder- runners under 8 MUST be accompanied on the course

Runner Affiliation: Club member Not a member

If a club member (affiliated) put your: Affiliated club:

(over 11) UKA number:

If you wish to make AgeUK
Rotherham a Donation
enter NUMBER of £ :

Entry conditions are here
Tick to confirm you accept: