the entry form

Dorchester Festival Charity 5Km Fun
Run and Walk
Date of Event: 11.00am, Monday 4th May 2015.
Registration:
To be received by Saturday 2nd May.
Course:
Flat mainly cross country course, mostly along grass footpaths, starting and
finishing in the vicinity of Dorchester Abbey.
Participants:
All ages welcome. U16s must be supervised by a responsible adult. Under 8s must
be accompanied by a responsible adult.
Awards:
All age groups below plus first male and first female villager.
Queries:
Contact : Jill Corran 01865 341696 or visit the Dorchester Festival Website
www.dorchesterfestival.com .
Payment:
After completing one on line application form for each participant and submitting
it, please go back to the main Festival site and click on “buy tickets” and select the
Fun Run and complete your payment by debit/credit card for the appropriate
amount.
Forename
Surname
Age
Sex (M/F)
Email Address
Postal Address
Male Age Groups
Emergency Tel No
Please
tick
Female Age Groups
Please
tick
Boys U8 (U8B)
Girls U8 (U8G)
Boys 8-11 (U12B)
Girls 8-11 (U12G)
Boys 12-17 (U18B)
Girls 12-17 (U18G)
Men 18-49 (M)
Ladies 18-49 (L)
Men 50+ (M50)
Ladies 50+ (L50)
For Families please complete a separate entry for each entrant.
Entry fee for a dog (no number issued)
Entry Fee In
advance ( by
4th May)
£3.00
£3.00
£3.00
£5.00
£5.00
£10.00
£0.50
I confirm that I have read and agree with the notices below (please tick)
For participants under 18 this form must be submitted by a parent/guardian
Entry Fee on
the day up to
10.30am.
£5.00
£5.00
£5.00
£7.50
£7.50
£15.00
£1.00
I am fully aware of the actual and potential risks in participation in this event
I declare that I will not compete in the race unless I am medically fit on the day of the race and
that, in any case, I will compete at my own risk
To the extent permitted by law, I accept that the organisers and sponsors of the race, or any of
their agents (including volunteers), will not be liable for any loss, damage, action, claim, costs or
expenses, which may arise in consequence of my participation of the event
Nothing in these terms of use shall exclude or limit the liability of the organisers or their agents
for death or personal injury due to its negligence or for its fraud
I grant my permission to PACT, the Dorchester Festival and its sponsors, assigns and licenses to
use or authorise others to use photographs, motion pictures, recordings, data or any other record
of my participation in this event for any legitimate purpose without remuneration
I accept that no refund can be given due to cancellation or postponement outside the organisers’
control. This includes adverse weather conditions
Organisers reserve the right to refuse entry if planned entry numbers have been exceeded
I agree to follow all traffic/highway laws and obey the directions of race volunteers and officials
FURTHER DETAILS WILL BE E-MAILED TO YOU UPON RECEIPT OF YOUR APPLICATION INCLUDING
INFORMATION ON HOW TO RAISE MONEY FOR OUR FESTIVAL CHARITY, PACT.