SOUTHERN Pedal for Paws reg form artwork print ready.pdf 1 13/07/2018 14:14:12

Important information a new a on dv rk en a tu b r m e E Rules and conditions of entry: • Strictly one entry form per person, including children. If you are part of a team please download the team information sheet and complete. • Entry forms must be returned with the correct entry fee which secures your place in Pedal for Paws. It is non-refundable. Pedal for Paws • Anyone under 16 must be accompanied by an adult; 2:1 ratio. Southern Cycle • If you have registered and fi nd that for any reason you are unable to take part please us know as soon as possible. You can give your place to someone else but you must let us know in advance. • Pedal for Paws is not a race and all riders must follow the Highway Code. Adults are advised to wear a helmet; all children must wear a helmet. w i s • If you are in doubt about your health or have a medical condition that could be aected by th er Ca rtn exercise, you should obtain a doctor’s certificate before participating in Pedal for Paws. nine Pa • Pedal for Paws is a sponsored charity ride and by taking part you pledge to raise as much sponsorship as possible – the suggested target is £100. • Both the Pace and Bound routes require cycling on roads. On your bike. Transform a life. • Closing date for entries is 21st September 2018.

C Sunday 30 September 2018

M Join us on one of our circular cycle routes. 4 Additional Infomation Y Choose from 29 or 52 miles. All routes start and finish at Canine Partners Southern Centre, CM Do you have any allergies, medical conditions or special dietary requirements of which organisers should be aware? Mill Lane, , , West GU29 0ED MY ……………………………………………………………………………………………………………...... …………………………………………… CY How did you hear about the event? For more information and to sign up, visit CMY …………………………………………………………………………………………………………………………………………...... ……………… caninepartners.org.uk/pedalforpaws

K We would love to hear why you have chosen to take part in this exciting challenge and who you are doing the ride for. Please attach your story to this form when you return it to us and confirm you give permission for Canine Partners to share your story.

5 Declaration (to be signed by accompanying adult if child aged 5-16)

I confi rm that I wish to take part in Pedal for Paws to help raise funds for Canine Partners. I understand that this cycle is not a race and that Canine Partners and its employees and volunteers cannot be held responsible for any personal injury, accident, loss, damage or public liability. I accept that any photos taken during the event might be used in future promotional materials.

I can confi rm that I am/my child is of reasonable health and fi tness.

I accept the rules and conditions of entry.

Signed: ...... Date: ......

Please return this registration form to: Pedal for Paws, Canine Partners, Midlands Centre, Ashby Road, Osgathorpe, Loughborough, Leicestershire LE12 9SR. Canine Partners, registered charity in and Wales (803680) and Scotland (SC039050). Canine Partners, registered charity in caninepartners.org.uk/pedalforpaws England and Wales (803680) and Scotland (SC039050) SOUTHERN Pedal for Paws reg form artwork print ready.pdf 2 13/07/2018 14:14:13

Please complete form in BLOCK CAPITALS and black ink

1 Your details

Hello Title: ...... First name: ...... Tel number: ......

Surname: ...... Mob number: ......

Email: ...... Canine Partners is delighted to be organising Pedal for Paws 2018: A sponsored bike ride in and around D.O.B: D D M M Y Y Y Y the South Downs National Park with the choice of two great routes; Pace and Bound with refreshment Emergency contact stops along the way. Address: ...... If you, the participant, are under the age of 16, please Pedal for Paws will have a staggered start time; cyclists taking on the longest Bound route will start at give the details of the adult cycling with you and ask ...... them to sign the declaration overleaf. 9am, cyclists doing the Pace route will start at 9.30am...... Name: ...... Both routes will start and finish at Canine Partners Southern Centre, Mill Lane, Heyshott, Midhurst, GU29 0ED. There will be food and refreshments available to purchase at our ‘race village’ so Postcode: ...... Tel number: ...... friends and family can come along too. All participants will receive refreshments on route and an exclusive Pedal for Paws medal on completion. They will also have access to our bike wash facilities and Your contact details will be kept on our secure database; we will not share your details with any third party organisations. mechanical support. If you wish to receive news or information from Canine Partners please tick here To tell us how you would prefer to be kept in touch with Canine Partners, visit our Communications Centre caninepartners.org.uk/stayintouch Group bookings of 10 or more will receive a discounted rate.

Our bespoke breathable Canine Partners cycle jerseys will be available to purchase on the day for £15. 2 The finer details C The are also available in advance through online shop. Adult £20 Child (up to 16yrs) £10 M Visit caninepartners.org.uk/pedalforpaws for more information. Group (10 or more) £15 each team member Y Select a route: Pace (9.30am) Bound (9.00am) CM Was £35 now £15 Cycle jersey size: XXS XS S M MY

The routes Cycling as part of a group? (Team leader to complete this form and download team form for additional riders) CY Team name:…………………………………………………………………………………………………………………...... CMY Cycling as part of a business or organisation? K Company name: …………………………………………………………………………………………………………………...... Pace - 29 miles Pace An exciting route with a few challenging hills, taking in the stunning South Downs National Park, 3 Payment and sponsorship (Full payment for all riders must be made here) this route heads North from Midhurst, out towards Total amount enclosed £ (add £10 for overseas postage) Petersfi eld and back via , , Didling, and Cocking.* Please make cheques payable to: Canine Partners Bound - 52 miles Billing Address: House name/number

The most challenging of our routes. This Bound Post code cycle will take you on the same route as Pace but further South encompassing the Queen Bound Pay by card: Mastercard / Visa / Switch / Delta (Please circle as appropriate) Elizabeth Country Park and Stansted Forest before returning via Elsted, Treyford, Didling, Bepton and Card no.:

Cocking once more.* Expiry date: Security code: (Last 3 digits on reverse of card) *Up to two children must be accompanied by at least one adult and cycle helmets must be worn Cardholder’s name: ...... …………………………………………………………………………………...... by all children. Signed: ...... Date: ...... Don’t forget to complete the declaration overleaf! This is a fundraising challenge event and we’d love each participant to raise a suggested target of £100, however every £1 of sponsorship is important to us. We will send you a For downloadable route maps visit caninepartners.org.uk/pedalforpaws sponsorship pack and give you as much support as you would like to help raise the money for Canine Partners.