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Jane Tomlinson's Walk for All_ Yorkshire Dales - Registration Form

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Jane Tomlinson's Walk for All_ Yorkshire Dales - Registration Form Powered By Docstoc
					                               Friends of the Children Foundation
                              “Walk for Monash Children’s”
                Feb 2013 Walk Registration starts 8.30 am SHARP
                 24th
   Jells Park Oak picnic Area Mel ref 72-A9 (enter from Ferntree Gully road)
                         Registration Form


Family Name                               First name

Male / Female                             Registration paid by cash or transfer?

Address

                                                       Postcode

Home tel.                                              Mobile tel.

Email

Which distance do you wish to take part in?


 5K                                  10K                                   15K


STATEMENT OF RESPONSIBILITY AND WAIVER (All participants must sign.)
I certify that I am sufficiently fit to participate in this event over the distance I have selected. I
understand that participation may involve risk to me and by participating in this event I accept such
risk. I will conform with all safety, housekeeping and other instructions given by the organiser. In
consideration of this entry being accepted, I waive all claims which I might otherwise have against the
organiser or any individuals or entities associated with the conduct this event and agree to hold each
of them harmless for any injuries which I may suffer as the result of my participation. I give permission
for my name and image to be published in association with this event.


Signed:                                                              Date:


              Thanks for your assistance and in raising sponsorships for the walk.
      Please return completed form to: FOTCF Team member or email to fotcf@hotmail.com
           11 Winifred Street, Oakleigh Victoria 3166 Tel 03 9564 8228 Mob. 0411415490
                                     www.friendsofthechildren.net
  Except registration fee of $15.00 all donations over $2 are TAX DEDUCTABLE, receipts provided
                               Friends of the Children foundation inc
                                   (A0050462F ABN 45959017245)

				
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