St.Levan Childrens' race entry form
Friday 17th August 2012 - Start time 7.02 PM
advance entries preferred but entry always available on the night
I accept that the organisers will not be liable for any
injury, loss, damage, action, claim, costs or expenses which may arise as a
consequence of participation in this event.
I declare that I will not compete in this race unless I am in good health
on the day, and in any event I will only compete at my own risk.
I agree to abide by UK Athletics rules.
I acknowledge that medical support will be provided by St.John Ambulance.
The information I provide on this form will be used solely for the
purposes of race results and identification for health and safety reasons and
will only be available to members of the results team and appropriate race
officials and will not be passed to any other person or agency. (Parent or guardian to sign for under 16ís.)
Sex_____Age on race day______Date of birth______________
Signature of parent/guardian____________________________
Please make cheques payable to St.Levan sports club and send to:
Steve Chapple, St.Levan 10k, 18 Bosorne Street, St.Just, Penzance, Cornwall,TR19 7LU
NB: Race numbers to be collected on the day. Receipt of entry will be e-mailed, please enclose SAE if further details are required.
Entry fees: £2 (in advance or on the night)
10k: use separate form.
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