C25k Registration - Widnes Running Club

Name *

First

Last

Date of Birth *

Enter your DOB in the format dd/mm/yyyy - for example 01/10/2000 for 1st October 2000

Address *

Address Line 1

City

State / Province / Region

Postal Code

Mobile Phone Number *

Email *

Confirm Email

Emergency Contact Name *

First

Last

Emergency Contact Number *

EA DECLARATION *

Club Code of Conduct *

Disclaimer *

I confirm that I understand that my participation in training sessions organised by the qualified leaders of Widnes Running Club at organised club sessions is entirely at my own risk and I should consult my own doctor if suffering from any condition that might make running injurious to my health.

Media Consent *

Please confirm you agree to Widnes Running Club publishing photographs or running achievements that may include you or your name on social media.

Digital Signature *

Please Type Your Full Name