Creswell Fun Run Flyer Entry v5.indd - Active Derbyshire

&
2012
Fun Run
Summer Celebration
Sunday 2nd September
Creswell Multi-Sports Pavilion
Registration 9.30-9.45am, Races to start at 10am
Three Fun Runs to choose from:
Mini, 2½ mile and 5 mile
Half of all proceeds will be donated to the
British Heart Foundation
Jog Creswell
jogcreswell@hotmail.co.uk
07792 497 303
Medals for ALL runners and prizes for first male and
female runners in each category
Register now to receive DISCOUNT ENTRY up until
29th August
Early Bird entry prices:
£2 per adult (14+) and £1 per child (U14)
On the day entry prices:
£3 per adult (14+) and £2 per child (U14)
Plus Active Creswell will be hosting a prize giving
ceremony for everyone who has joined in with the Active
Creswell Summer Loyalty Scheme. There will be lots of
activities and things to see and do on the day! So come
down and join us!
Entry form on reverse to be cut off and returned.
(Please cut off and keep when submitting your entry form)
Key Information
Please see contact details overleaf.
Event: Jog Creswell Fun Run & Active Creswell Summer Celebration
When: Sunday 2 nd September 2012. Arrive 9.30 - 9.45am.

Jog Creswell Fun Run 2012 Registration Form
Please enter participants details below:
Name
Age
Which Event (Please tick)
Mini 2½ mile 5 mile
If you need more space please put the above details on a separate sheet and include with this entry.
£
I include a cheque/cash to the total of
(Please make cheques payable to Bolsover District Council)
for child entries (at £1 each) and adult entries (at £2 each).
Post your entry form and fee in an envelope and place in boxes situated at Creswell Leisure Centre
or Clowne Contact Centre, or alternatively send entry form and cheque to Laura Stephen, Bolsover
District Council, Leisure Services, Riverside Depot, Mansfield Road, Doe Lea, Derbyshire, S44 5NY
Lead Contact Details
Contact Number(s):
E-mail Address:
Home Town/Village:
Are there any medical conditions/medications we need to be aware of for any of the participants?
If so please provide details:
Emergency Contact details
Please provide a contact who is not participating in the event.
Name:
Phone Number:
Relation to lead contact:
This event is organised and led by volunteers, coaches and activity leaders. Participating in this event is
done so at your own risk and by completing this form you confirm you understand this and are willing to take
part.
Occasionally photographs may be taken of activities for the purposes of general publicity by authorised staff
and all attire and posture will be appropriate. If you do not consent to photographs being used in this way
then please put a cross in this box.
All personal information provided to Village Games and it’s partners will be held and treated in confidence in
accordance with the Data Protection Act 1998. It will only be used for the purpose it is given. We may contact
you via e-mail to provide you with information about other relevant activities which may interest you. If you do
not want to be contacted for that purpose please tick this box.
Find the event on Facebook search: Jog Creswell Fun Run & Active Creswell Summer Celebration
Fun Run enquiries: Rob 07792 497303
Active Creswell Loyalty Scheme: Laura 07909 444094