Online Entry Primary Entrant / Main Contact Details (Adult) Primary Entrant and Main Contact Address Street Address Address Line 2 City County Postcode Email* PhoneTeam name (optional) Additional EntriesAre you willing to raise sponsor monies in addition to your entry fee? Yes No Would you consider making a voluntary contribution? Yes No Please Tick which charity(s) you wish your sponsorship raised to support: Manorlands Yorkshire Cancer Research Rotary Charities Equal amounts Own Charity Name of Own Charity? Adults Price: £ 12.00 Quantity: Children Price: £ 8.00 Quantity: Extra Donation Total £ 0.00 If you are paying UK income tax and agree to donate through ‘Gift Aid’ we can reclaim from HM Revenue and Customs (The Tax man!) 25p in every pound donated. This does not cost you personally. Yes No Terms and Conditions of Entry I /WE HAVE READ AND UNDERSTAND THE TERMS AND CONDITIONS OF ENTRY AND I / WE AGREE TO THE DECLARATION I agree Yes No . DECLARATION (for u16s, agreement to the terms is by the parent or guardian) 1. The adult primary entrant named declares that he / she and the other people named on this form are medically fit to take part and they enter at their own risk. They understand that the organisers cannot be held responsible for any illness incurred during or as a result of my/our participation in this event or for any property lost, stolen or damaged. I agree to abide by the Highway Code and event rules as displayed at the start venue. 2. It would be appreciated if entrants raising money for their own charity could inform the Santa Fun Run Treasurer on info@shamrockshuffle.co.uk of how much sponsorship money they have managed to raise. This would allow the total amount collected at the Shamrock Shuffle Run to be published in the local Craven Herald newspaper after the event
