Jurassic Coast

Thank you for your interest in our challenges, Please complete the following registration form.

Fields marked with * are Mandatory fields

Challenge Title

Challenge Date :*

Challenge Type :*

Charity Name :

Charity Telephone:

Area Code

Phone Number

Name:*

First

Last

Address:*

Street AddressCityState / Province / RegionPostal / Zip CodeCountry

E-mail:*

Home Phone:*

Area Code

Phone Number

Mobile Number :*

First 5

Remaining 6 numbers

How did you hear about us?

Please tell us more :

Do you suffer from any medical condition which may stop you from completing this event or that you feel we should know about?

Medical Condition :*

Medical Conditions :

Do you take any tablets or medicine we need to know about or that may affect your participation?

Medicine Required :*

Medicine Details :

Do you have any special diet/foods e.g. Vegetarian?

Dietary Required :*

Dietary Details :

Next of Kin Name : *

First

Last

Next of Kin Emergency Number :

Area Code

Phone Number

Please read this Agreement carefully :

Deposits paid are non-refundable if you cancel the trip less than 62 days before the start date. If you cancel less than 21 days before the trip then any further monies paid are less 75% of the balance paid. Should you cancel the trip during the last 10 days up to the trip then no monies paid are refundable. If we cancel the trip due to insufficient numbers or other reason then you will be offered a full refund or an alternative trip of similar value unless you choose to pay extra for a higher value trip. In any event we will endeavour to run every trip booked and to work with the participant to our mutual benefit. It is important that we have a fully completed registration form including contact address and telephone numbers of next of kin, participant and their medical details. Once a completed form is received by us and registration fee paid then the participant shall have deemed to have registered and entered into a contract regarding the event and be bound by the conditions stated. All trips offered by nature involve a degree of hazard. Participants will benefit a lot by gaining some degree of fitness to cope with the activity involved. While participating in the activity, If a participant conducts themselves in a violent or offensive manner to either staff or other clients then they may be asked to leave the trip without any recompense. If you have any special dietary requirements or otherwise then please inform us. On trips involving camping or hotels, participants are offered rooms or tents sharing with a fellow participant of the same sex. If you have any friend or partner who you wish to share with then please inform us before the event. We will do our best to help with any problem if we are informed about it before the event.

I have read and understood the above Agreement :*

Yes

Before you continue :

By submitting this form you will be taken to PayPal to pay the registration fee listed below. By taking this action you agree to the registration fee and understand this is non-refundable within 62 days of the event, unless Outdoor Challenge Events cancels the trip due to low numbers or similar.

You also confirm that you (the person listed on page 1) are over 18 years old, and are fit enough to take part in the event and the information provided is true and correct.

Word Verification:

The following shows how much you will need to pay at this stage;

Total: