1. Derby Fun Run 3km walk, jog, run Sunday 17th April 2016 10:30
Parent name: ………………………………… Child Class:………
address : ……………………………………………………………
Mobile number: …………………………….(emergency contact on the day)
3km walk, jog, run
Sunday 17th April 2016
10:30
Pride Park
Entry 1:
Full name: ……………………………………… Gender: M / F
DoB: …………………… Medical condition: ……………………….
Entry 2:
Full name: ……………………………………… Gender: M / F
DoB: …………………… Medical condition: ……………………….
This friendly event is open to all: children, teachers, staff, their friends and family, pushchairs, wheelchairs, walkers, 1st time runners, PB chasers…
Entry 3:
Full name: ……………………………………… Gender: M / F
DoB: …………………… Medical condition: ……………………….
Entry 4: FREE!
Full name: ……………………………………… Gender: M / F
DoB: …………………… Medical condition: ……………………….
ALL WELCOME!
4 good reasons to join:
Get fit for spring!
Raise money for school and Cancer Research
Medal to all finishers.
Finishing lap around the iPro stadium.
Add extra applicants on reverse
Cost: £5 per runner (4th entry free)
I am medically fit to take part and I enter at my own risk.
I will not hold responsible the organisers or any person involved in the event for any injury/illness or for any property lost, stolen or damaged.
I give my permission for free use of my name, voice or picture in any broadcast, telecast, advertising promotion or other account of this event.
If I am under 18, my parent/guardian has agreed for me to participate.
If I am under the age of 9, I must be accompanied by a responsible adult.
Please return your entry form with payment to school by 21st March or us:
£……. enclosed
Signature: …………………………………