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RACE2 PRAGUE 2017

THE UNIVERSITY OF ST ANDREWS CHARITIES CAMPAIGN


CONSENT FORM
Booking Confirmation Number(s):
______________________________________________________
Team name: ________________________________ Team number (if known):______
Hall/Society/AU Club:
________________________________________________________________
Racer 1
Name:___________________________

Racer 2

Age:_____________________________

Age:______________________________

Term Address:____________________

Term Address:_____________________

_________________________________

_________________________________

_________________________________

_________________________________

Saintmail:_________________________

Saintmail:_________________________

Mobile:___________________________

Mobile:___________________________

Next of Kin:_______________________

Next of Kin:_______________________

Relation:__________________________

Relation:__________________________

Home Phone:______________________

Home Phone:______________________

T-Shirt size:________________________

T-Shirt Size:________________________

Nationality: ________________________

Nationality: _______________________

Matric Number: ____________________

Matric Number: ____________________

Will you require assistance with

Will you require assistance with

Visas? Y/N

Visas? Y/N

Would you be interested in

Would you be interested in

purchasing a Race2 beanie hat or

purchasing a Race2 beanie hat or

hoodie? Y/N

hoodie? Y/N

Name:___________________________

WWW.CHARITYRACE2.ORG.UK
THE UNIVERSITY OF ST ANDREWS IS A REGISTERED CHARITY IN SCOTLAND
SCOTTISH CHARITY NO. SCO 19883

Racer 3 (optional)
Name:___________________________
Age:_____________________________
Term Address:____________________
_________________________________
_________________________________
Saintmail:_________________________
Mobile:___________________________
Next of Kin:_______________________
Relation:__________________________
Home Phone:______________________
T-Shirt size:________________________
Nationality: ________________________
Matric Number: ____________________
Will you require assistance with Visas? Y/N
Would you be interested in purchasing a Race2 beanie hat or hoodie? Y/N

DECLARATION
I confirm that I have read and accepted all the terms and conditions of the
University of St. Andrews Charities Campaigns Race2 Prague. I also agree to
follow all the rules outlined for the race. I understand that I am responsible for
the safety of myself and my belongings for the duration of the race. It is also my
responsibility to provide insurance for the journey if I care to do so. I am
responsible for all surplus transport, food and accommodation costs during the
event, not included in the Sign Up fee.
Racer 1 Signature:____________________________________ Date:______________
Racer 2 Signature:____________________________________ Date: ______________
Racer 3 Signature:____________________________________ Date :______________

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