FfS NightWalk registration form



4102100-22479000Carrots NightWalk 2014We are thrilled that you have decided to support the Birdshot Uveitis Society (BUS) and join Fight for Sight’s Carrots NightWalk. Please fill in the form below to tell us everything we need to know for the night. Please fill in a separate form for each adult. Under 18s must be registered on an accompanying adult’s form. Under 13s may only walk the 6 mile route (no registration fee is required for under 13s). Please return your completed registration form to: Birdshot Uveitis Society, PO Box 64996, London SW20 2BL along with a cheque for your ?25 registration fee made payable to Birdshot Uveitis Society. If you have any questions, please email: info@.uk BUS Registered Charity Number 1145349 HYPERLINK "" .uk 539750-4381500Personal detailsTitleFirst nameSurnameAddressPostcodeDaytime telephoneEmail536575-95694500Under 18s accompanying you:First nameSurname Age539750-11557000Choice of route: Birmingham / Bristol / Glasgow / London/ Oxford (please circle)417576049022000The minimum age for the 15 mile route is 13, while shorter 6 mile route is open to all ages. Which route would you like to register for?539750609600056140353568700015 mile route (participants aged 13 and above)6 mile route (participants of all ages)539750-4381500What else we need to know4935220-15240004359275-152400053975095250005511165-1524000I am 18 or above. Please confirm your date of birth://Anyone aged under 18 must be accompanied by a responsible adult.T-shirts will be issued on the night for you to wear on the walk. Please specify how manyT-shirts you need in each size, bearing in mind that this will be worn over a layer of clothing:693420-45720001153160-45720001612900-45720002174240-4572000SMLXL53975025971500If you are entering as part of a team, e.g. a group of friends, please tell us the team name.Team name318960524384000376682024384000Does anyone named on this form have any medical conditions or accessibility and/or mobilityneeds which we should be aware of?YesNoIf yes please state53657525654000Who should we contact in case of an emergency?NameTelephone53657525654000Do you know anyone who may be able to volunteer as a marshal on the evening?NameTelephone53975025971500How did you hear about this event?37858706032500Will your employer match the funds you raise?YesNo4362450-40767000I confirm that I have read and understood the terms and conditions for the53975022796500Carrots NightWalk 2014 given on the following two pages:SignatureTerms and conditionsThese terms and conditions apply to your participation in one of Fight for Sight's 2014 “Carrots NightWalk” (hereinafter referred to as “Carrots NightWalk 2014”) and for all associated transactions.ParticipationThere is no minimum age requirement for the 6 mile walk. For the 15 mile walk participants must be 13 years of age and above to participate. However all participants under 18 years of age must be accompanied by an adult in either walk. Fight for Sight cannot take responsibility for under 18s on the night.Guide dog owners are advised to contact Fight for Sight on 020 7264 3900 ahead of the event to make the appropriate arrangements.If you are a wheelchair user or you wish to undertake the route of the walk on a mobility scooter please contact Fight for Sight on 020 7264 3900 to make the appropriate arrangements. “Carrots NightWalk 2014” is a non-competitive event. Running is not allowed. Event officials will not allow runners to continue to take part.No pets or roller skates/blades are allowed on the walk.If you are bringing a pushchair/stroller please contact Fight for Sight on 020 7264 3900 to make the appropriate arrangements.Fight for Sight reserves the right to refuse entry if for whatever reason it is deemed unsafe for the participant to take part.All participants must abide by any instructions or regulations displayed or given on the night of the event by police and event officials.Event officials will determine whether those arriving late at the start of the event will be permitted to take part.SponsorshipAll participants have a legal responsibility to ensure that all sponsorship monies and donations received for the “Carrots NightWalk 2014” are paid to the Birdshot Uveitis Society (BUS) . Please ensure that all sponsorship raised is received by the Birdshot Uveitis Society (BUS) by Friday 1st November 2014.Health and safetyParticipants are responsible for their own medical conditions. If participants are in any doubt about their physical ability to take part in the “Carrots NightWalk 2014” then they must consult their general practitioner prior to the event.We strongly advise that all participants write their name and details of any health problems or current medication on the reverse of the badge given to them at the registration point on the night. This badge must be worn during the event.Fight for Sight is organising this event following best practice guidelines and health and safety standards as outlined in the Health and Safety Executive’s Event Safety Guide. Participants enter the “Carrots NightWalk 2014” at their own risk and Fight for Sight and associated companies shall not be liable for any injury or loss to participants or their property that may occur as a result of their participation in the “Carrots NightWalk 2014” event other than where such injury or loss is a result of Fight for Sight’s negligence.Fight for Sight will take all reasonable steps to minimise the risk of injury to participants taking part in the “Carrots NightWalk 2014”. There is a stringent risk assessment process in place for this event which aims to minimise or eliminate the risk to everyone taking part. By taking part in this event, all participants acknowledge that there may be conditions or circumstances beyond Fight for Sight’s control that can lead to unforeseen risks. If there are any concerns or queries please contact Fight for Sight before agreeing to take part in this event.In the case of an emergency Fight for Sight may pass personal details provided by each participant to the emergency services and health care professionals and also use such details for the purposes of contacting individuals’ emergency contacts.All spectators at the “Carrots NightWalk 2014” do so entirely at their own risk and Fight for Sight shall not be liable for any injury or loss that might occur as a result of their attendance other than where such injury or loss is a result of Fight for Sight’s negligence.GeneralFight for Sight reserves the right to change the “Carrots NightWalk 2014” routes (this applies to all of our Carrot NightWalk events).Fight for Sight operates a no smoking and/or alcohol policy at events and respectfully asks all participants along with their supporters to refrain from smoking or drinking alcohol at the event. In addition to this Fight for Sight asks that all participants refrain from drinking excessive amounts of alcohol on the day leading up to the "Carrots NightWalk 2014".Fight for Sight respectfully asks all participants along with their supporters not to use aggressive or abusive language towards the event officials, organisers and volunteers.Fight for Sight respectfully asks all participants and their supporters to be respectful of local residents while out on the route and not to make any excessive noise. Please also ensure that appropriate litter and recycling facilities on the route are used.By taking part, all participants confirm that they are happy for their names and any footage or photographs taken during their participation in the “Carrots NightWalk 2014” to be used to publicise the event or Fight for Sight or National Eye Health Week generally, including television broadcasts, publications, marketing materials and other documents that may be made available to the public. No photographs of children will be used without written consent of a parent or guardian aged 18 and over. Fight for Sight will not provide your details to third parties.British Eye Research Foundation operating as Fight for Sight is a company limited by guarantee registered in England (company number: 05525503) and a charity registered in England by the Charity Commission for England and Wales (Number: 1111438) ................
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