snowdon application form

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					           The Snowdon Challenge

        Saturday 20th October 2012

Please print clearly:

Title……………….Surname…………………………………Forename………………………………..

Address……………………………………………………………………………………………………………

……………………………………………………………………..Post Code………………………………….

Telephone Home…………………..............                    Mobile………………………………………

E-Mail Address………………………………………………………………………………………………….

Date of Birth ……………………………………                    Male                Female

Emergency Contact Details (a friend or relative not taking part in the event).

Full name ………………………………………………………………………….

Relationship to you …………………………………………………………..

Telephone Number ……………………………………………...............

What level of mountain/ hill walking / trekking do you have?

Experienced                 Some experience                         Inexperience

Please give details of any medical problems such as diabetes/epilepsy/high blood pressure/
allergies etc.
(If you have any medical problems please seek professional advice before participating in this event).

……………………………………………………………………………………………………………………………………………….

Terms and Conditions

       Participants aged 16 or under must be accompanied and supervised by a responsible adult.
       The organisers reserve the right to cancel the event or change routes specified for safety reasons
        because of adverse weather conditions.
        Taking part in The Snowdon Challenge is at your own risk and Shropshire Smile will not be liable for
        any injury or loss that may occur as a result of your participation.
       Participants are responsible for their own health and wellbeing. If there is any doubt about your fitness
        you should consult your doctor before signing up for this event.
       By taking part, participants confirm they are happy for photographs taken during the course of the
        event to be used by Shropshire Smile for publicity and promotional services.
       Participants must raise or donate a minimum of £40.


    Signed…………………………… Print Name..………………………………………….                                 Date…………………

    Entries to: Debbie Smith. 25 Goldstone Drive, Bridgnorth, Shropshire. WV16 4NE

				
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