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Participant First name

Participant Last name

Participant Birthday

Month

Day

Year

Any medical information that we need to be aware of:

For additional participants, please submit this form and then fill it out again, each participant will need a form submitted

Name of adult who is responsible for child on the day (If applicable)

Emergency Phone Number

Email

Approximately, when can we expect to see you over the weekend? (Tick as many times as you like, feel free to come and go as you please)

Saturday lunch time - 11:30am - 1:30pm

Saturday afternoon - 1:30pm - 5:30pm

Saturday evening / Cartwheel disco - 6pm - 9pm

Sunday morning - 10am - 12pm

Sunday afternoon - 12pm until Marathon finish

I understand that this is to raise money for the Academy Of Movements BIG RIG Upgrade and will donate after filling out this form based on the following:

£5 Cartwheel Marathon Entry
£5 per each record attempt (pay this via cash on the day OR scan QR code on the day)

I understand that additional to the entry fundraiser fee that a sponsorship form is required, and I will collect sponsors for myself or my child for the event

Social media / Marketing Permission - Photos & Video

I give permission for either myself / my child to appear in marketing material

I do not give permission for any photos or videos taken to be used in marketing material

By signing below, I confirm that either myself or my child is in suitable health and physical condition to participate in the Cartwheel Marathon or any selected record attempts on the day

Signature

Academy Of Movement

1A Boldero Road, Bury St Edmunds, IP32 7BS

info@academyofmovement.co.uk

07934954741

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