Sunday 19th April 2015
Personal Information
Name:
Address 1:
Address 2:
Town:
Postcode:
Date of Birth:
Email:
Contact No:
If you have a special reason for taking part please let us know
Are you happy for us to use your story to publicise our event?
How did you hear about the event?
Registration Information
Employer’s name
Does your employer operate a match giving scheme?
Registration Fee - £20 per person
Cheques should be made payable to CLIC Sargent
This deposit is non refundable. If you would prefer to pay via credit card, please call 0141 572 5700
Sponsorship:
I pledge to raise a minimum of £120 to take part in this event
I accept these Terms & Conditions stated overleaf
signed:………………………………………
Terms & Conditions
Entering a fundraising event is personal to you and you may not change places with another person without informing CLIC Sargent 7 days prior to the event date.
1. All participants enter this event entirely at their own risk and CLIC Sargent shall not be liable for any injury of loss that might occur as a result of your participation.
2. CLIC Sargent takes all reasonable steps to minimise the risk of injury to participants during fundraising events. There is a stringent risk assessment process in place for each and every event which aims to minimise the risk to everyone taking part. However, by taking part in this event, you acknowledge that there may be conditions or circumstances beyond our control that can lead to unforeseen risks. If you have any concerns or queries please contact us before agreeing to take part in this event.
3. All participants must abide by any rules, instructions and regulations provided in advance, displayed or given on the day by CLIC Sargent staff and contracted agencies, police and officials.
4. In return for a guaranteed place on a CLIC Sargent fundraising event, you must pay to CLIC Sargent the stated registration fee (which is refundable only in the unusual circumstances that an event has been cancelled by CLIC Sargent) and commit to raising at least the further target amount of sponsorship. The stated target sponsorship level is exclusive of gift aid on sponsorship.
5. If you are unable to obtain the target amount of sponsorship you may choose to make up the balance yourself.
6. Should you have to withdraw, there will be no refund payable to you as your sponsorship was raised for charitable purposes. All sponsor forms and monies should be forwarded to the charity or returned to the sponsors.
7. Any monies raised in connection with a CLIC Sargent event must be passed to CLIC Sargent.
You can:
� Pay in online with your credit or debit card onto one of the fundraising websites such as www.virginmoney.com or www.justgiving.com
� Call us on 0141 572 5700 with your credit or debit card details.
� Send cheques made payable to CLIC Sargent to: 22-24 Links Road, Prestwick, KA9 1QG
8. Should you not be able to take up your place all sponsorship monies should be returned to your sponsors (or, if they agree, given as a donation to CLIC Sargent).
9. You must be aged 16 years or over to participate in this event.
10. Any participant unsure of their physical ability to take part in a CLIC Sargent event should take medical advice from a general practitioner prior to the event. It is your responsibility to ensure that you are medically fit to participate and it is extremely important that you are realistic and truthful about your capabilities and level of experience.
11. By taking part, all participants confirm that they are happy for their names and any footage or photographs taken during their participation in a CLIC Sargent event to be used to publicise our work, including television broadcasts.
12. Participants' supporters and family members who spectate at events entirely at their own risk and CLIC Sargent shall not be liable for any injury or loss that might occur as a result of their attendance other than as a result of CLIC Sargent’s negligence.
13. All transfers to and from the venue are at the participant's own expense. You will be given specific guidance about whether food and drink are included in relation to each event.
14. CLICS Sargent may need to cancel an event or withdraw a place and then only your registration fees will be refunded. If payment from your sponsors is conditional on your completing the event then they will be repaid. CLIC Sargent has no other liability to you in respect of the fundraising event.
CLIC Sargent is a company limited by guarantee with charitable status.
Charity Registration number: 1107328/SC039857.