Leeds Rhinos Foundation

Leeds Rhinos Foundation

Changing Lives Through Sport

Run with The Rhinos Registry

Register now for Run with The Rhinos.
Run with The Rhinos 2017

Please only submit one form per person. All fields are mandatory, please complete in BLOCK CAPITALS.


Upon completion the information this form will be accessed by Jessica Bowman at Leeds Rugby Foundation so that you can be contacted in relation to paying to register.


Keiran Smith
Leeds Rhinos Foundation
Leeds Rugby Retail Store
Headingley Carnegie Stadium
St. Michaels Lane
Headingley
Leeds
LS6 3BR

FOR FURTHER INFORMATION PLEASE EMAIL: keiran.smith@leedsrhinosfoundation.org



Where did you hear about the Run with the Rhinos?


  
*


What made you want to take part in Run with the Rhinos 2017?


  
*


What time are you hoping to complete the race in?


  
*


T-shirt size?


   S   M   L   XL   XXL
*


Would you like more information on other Leeds Rhinos Foundation events?


   Yes   No
*


In the past week, on how many days have you done a total of 30 minutes or more of physical acvity, which was enough
to raise your breathing rate? This may include sport, exercise, brisk walking, or cycling for recreaon or to get to and from places, but should not include housework or physical activity that maybe part of your job (Please tick as appropriate)


   None   1 day   2 days   3 days   4 days   5 days   6 days   7 days
*


Would you be willing for your local media to publicise your fundraising for the Leeds Rhinos Foundation?


   Yes   No
*


Does your place of work offer a ‘match funding’ scheme?

You can usually find this out on your employers’ website, or be asking your management team/HR department


   Yes   No
*


If you answered yes to 'match funding', please give details of the scheme and who your employer is


  

Would you be willing to apply to a match funding scheme?


By applying to these schemes, your employer may match a total or percentage of what you raise. The company will benefit from this too, as it will help them towards their corporate social responsibility targets.
   Yes   No   N/A
*


Please fill your name in here and the date of submission to sign the form, BY SIGNING THIS AGREEMENT YOU ARE
AGREEING TO THE TERMS AND
CONDITIONS LISTED


  
*


Tick box if you DO NOT WANT to receive email updates and race details on this and future Leeds Rhinos Foundation events.

The above details will be stored on computer for future mailings.

By completing this application form you consent to the collection, storage, processing and use of your personal information in accordance with the Data Protection Act 1998 or any amendment or replacement of the same.


   Opt out

Your details

Fields marked * are required

First name:
*
Surname:
*
E-mail address:
*
Postcode:
*
House name/number:
*
Street:
*
Town:
*
County:
*
Phone number:
*
Mobile number:
*
Date of Birth:
*
Gender:
*
Emergency Contact:
*
Emergency Address:
*
Emergency Number:
*


If you're human leave this blank:
*





Competition rules

TERMS AND CONDITIONS

By signing the application form you agree to the following conditions:

1. By signing this form you agree to complete the Leeds Rhinos Foundation entry process and fundraise for Leeds Rhinos Foundation.

2. Should you not be able to take up your place, the people who sponsored you are required to ask for a refund (letter or email) before we can return their monies to them.

3. You must be at least 17 on the day of the event.

4. Participants taking part in the event must be satisfied that there is nothing in their medical condition which could mean there is any danger in taking part. The Leeds Rhinos Foundation does not accept liability if anybody is injured on the run, the Leeds Rhinos Foundation advises participants to have a medical check up before running and to abide by any advice that may be given as a result of such check-up.

5. Participants in the event take part at their own risk. Leeds Rhinos Foundation cannot be held responsible for loss or injury caused by its own negligence. Participants should obtain adequate insurance cover where appropriate for taking part and for cancellation.

6. All fundraising benefits offered by Leeds Rhinos Foundation are subject to terms and conditions detailed on http://www.leedsrhinosfoundation.org/events/run-with-the-rhinos.php

© 2017 Content Copyright Leeds Rhinos Foundation Privacy & Cookies delivered by Sotic powered by OpenText WSM