If you are aged 14 to 17, please tick to signify parental consent
Do you have any medical conditions we should be aware of? If you don't, please enter 'none' in the box.
I confirm that I wish to enter The Midnight Walk and understand that I do so at my own risk and St Peter's Hospice will not accept liability for any injury or loss as a result of my participation but I understand that my statutory rights remain unaffected. I agree that I should seek medical advice from my general practitioner if I am in any doubt as to my physical ability to participate in the event. By completing this form I am giving my permission for any photographs taken of me on the night to be used in future publicity.
We would love to keep you updated with news about our work and fundraising activities. We will never sell your personal information to third parties, but we may need to share your details with suppliers who work on our behalf. See our Data Protection Policy on our website for more information on how we use and protect personal information. You can change the way we communicate with you at any time by calling us on 01275 391400 or emailing email@example.com