St Vincents

Telephone: 0113 248 4126
Home > Yorkshire 3 Peaks Registration

Yorkshire 3 Peaks Registration Form

Thank you for your interest in St Vincent's Yorkshire 3 Peaks Challenge. We'll need to take a few details to get you signed up. Please click "Next" once you have finished filling this page to complete your applications. to go back through your application please use the "previous" button at the bottom of each page. DO NOT refresh or use your browser to go back as this will reset the form. If you have any questions or would prefer to complete your form by post, please contact Natalie on 0113 248 4126 or email natalie.tiu@stvincents-svp.org.uk  

Your Details

1. Personal Details

Challenge Details

2. Choose Your Challenge

Please choose one below:

Emergency Details

Next of Kin/Emergency Contact Details

Please give details of the person you would like us to contact in case of emergency. N.B This should NOT be someone taking part in the challenge with you

The information you supply will only be disclosed to the SVP 3 Peaks Challenge Event Team. Please give full and accurate details.

Medical History

In case of accident or emergency, we will endeavour to pass on details of the person(s) involved to the emergency services.
If you have no medical conditions to disclose, please type in "none" to move on to the next page.

Declaration

Terms & Conditions. IMPORTANT - PLEASE READ CAREFULLY BEFORE SUBMITTING FORM

In the event of an accident or illness whilst on the Challenge, I hereby give permission for SVP to initiate any medical treatment deemed appropriate and to inform my next of kin or emergency contact (as detailed on this form). To the best of my knowledge I confirm that my mental and physical health and fitness is appropriate for this challenge and I accept that this is a physically demanding event for which I take responsibility for ensuring I am fit and able to take part. I confirm that the information provided on this form, to the best of my knowledge, is true and correct. By signing this form I agree to the terms and conditions for the event and agree to abide by the decisions taken by the Challenge Event Team and follow all reasonable instructions on the day. By signing this form I agree to the terms and conditions for the event and agree to abide by the decisions taken by the Challenge Event Team and follow all reasonable instructions on the day.
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Photo Consent & Conditions of Use
We will have a photographer at this event and may wish to use a photograph of you in our publications, publicity materials, displays, through our social media channels or on our website. (Please see conditions for this below)
I am happy for my/our photograph(s) to be used by SVP: (please tick all that apply)
Conditions of Use
1 This form is valid for four years. We may apply to you to extend your permission after this time 2 The information you provide will be stored on a database for use by the , St Jude's and St Vincent's Support Centre only (both part of the St Vincent de Paul Society) and will not be shared with or sold to any third party. 3 If we use photograph(s) of individuals, young people or small groups of young people, we will avoid using their names in accompanying text or captions. We may use group photographs in general captions. 4 We will not include personal details such as telephone numbers or addresses in any of our publications. 5 Please note that websites can be viewed throughout the world and not just in the UK where UK law applies.