TEAM REGISTRATION FORM Thank You So Much for Taking on the Challenge of the Yorkshire Three Peaks As a Team to Support York Teaching Hospital Charity

TEAM REGISTRATION FORM Thank you so much for taking on the challenge of the Yorkshire Three Peaks as a team to support York Teaching Hospital Charity. Please complete the form below to register your places.

If you would like to register as an individual then please request an Individual Registration Form from [email protected]

Team Name: Main Contact Person Title: Full Name: Home Address:

Postcode: Contact Number(s): Email: Twitter @ Mobile Work place: Could your employer commit to match your fundraising? Work Address:

Postcode:

Our Yorkshire Three Peaks partners are Kuta Outdoors Ltd. (www.kutaoutdoors.co.uk). The event will be managed by their highly experienced and qualified outdoor leaders and their ethos is to encourage, involve and engage safely.

The challenge starts in the heart of the Yorkshire Dales, early in the morning; you will need to arrange your own transportation: Yorkshire 3 Peaks Start Point, Station Road, Horton-in-Ribblesdale Nr. Settle, North Yorkshire, BD24 0HF

Why York Teaching Hospital Charity? We’d love to know your team’s reasons for supporting our charity

Registration Fee & Fundraising We require a £25 registration fee per person to secure your place; this covers the organisation of the event. The suggested minimum sponsorship for the Yorkshire Three Peaks Challenge is £125 per person, this money will support our Dementia Appeal, making our hospitals better for patients living with dementia while are

Registration Fee [ ] Cash [ ] Cheque, payable to ‘York Teaching Hospital Charity’ [ ] Credit or Debit Card, please phone 01904 724521 for secure payment [ ] BACS, put your ref as ‘Y3P17YourName’ £ (Sort Code 20-99-56, Account Number 10989649) [ ] If you require an invoice, who should we send it to? £25 per person

How much is the team Please let us know how your team plans to raise money: aiming to raise?

Money raised through this challenge will support our Dementia Appeal. www.york.nhs.uk/dementiaappeal If you would prefer to support a different department please let us know.

Terms & Conditions By taking part in the Yorkshire Three Peaks Challenge you agree to the following terms and agree: 1. To ensure that all team members have completed the group booking information form. 2. To make every effort to exceed the suggested minimum sponsorship target of £125 per person. 3. To send on any funds raised directly York Teaching Hospital Charity within 1 month of your challenge. 4. Once booked, your £25 per person registration fee is non-refundable. 5. Your team contact details will be shared between York Teaching Hospital Charity and Kuta Outdoors. 6. You confirm that you and all members of your team have read and accept Kuta Outdoors terms and conditions, visit http://www.kutaoutdoors.co.uk/terms-and-conditions-2018/ for details or by email [email protected] for a copy. 7. You and the members of your team enter the challenge entirely at your own risk and York Teaching Hospital shall not be liable for any injury or loss which you or any members of your team may suffer or incur as a result of your participation in this event. It is each individuals responsibility to prepare and ensure an appropriate level of fitness to take part. 8. You and members of your team are happy for York Teaching Hospital Charity to use your name, any footage or photographs taken of you during your preparation for and participation in the event in future marketing materials. 9. To keep York Teaching Hospital Charity informed of any changes to your contact details.

Signed: Date: / /

Print Name:

ALL TEAM MEMBERS MUST COMPLETE THE GROUP BOOKING INFORMATION FORM

Please return both forms by email to: [email protected] Or by post to: Fundraising Hub, York Hospital Wigginton Road, York, YO31 8HE

Thank you for supporting York Teaching Hospital Charity, we would love to keep in touch.

Please let us know if you would like to hear about where money raised is helping in our hospitals and future fundraising events and campaigns. [ ] By Post [ ] By Email [ ] By Phone

Please let us know if you would like to hear from us about volunteering opportunities when they arise. Please contact me [ ] By Post [ ] By Email [ ] By Phone

You can read our full data protection policy on our website at www.york.nhs.uk/fundraising GROUP BOOKING – Team Name:______

Confirm Mobile Phone T Shirt Fitness What is you have Emergency Size Comments /Health Email Number Level your read & Full Name XS, S Contact Name & address (to be carried on 1-3* target accept issues M, L, XL Number the day) time? T&Cs

*Fitness Levels 1 - Very high – easily walk/run 20miles 2 - Average – regularly walk 10-15 miles 3 - Low - do no or little walking

If you have a health condition that causes concern, Kuta Outdoors Ltd may ask for a doctor’s note before allowing you to complete the challenge. Conditions include but are not limited to: heart conditions, breathing difficulties/lung conditions, spinal conditions or back problems, visual impairment, recent surgery or if you are pregnant. If you have any questions or concerns please contact Phil at Kuta directly on 07762791383.

GROUP BOOKING – Team Name:______

*Fitness Levels 1 - Very high – easily walk/run 20miles 2 - Average – regularly walk 10-15 miles 3 - Low - do no or little walking