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DRC Walk2Run 2019 Registration Form
Please read Walk2Run course overview and FAQ's before submitting this form.

You must be 18 or over to join Walk2Run.

Walk2Run Evaluation Morning is Saturday 5th January 2019 at 10.30am

Walk2Run will run for 12 weeks every Tuesday evening from Tuesday 8th January until Tuesday 26th March 2019, meeting at the club at 17.55.

On Saturday 31st March 2019 we will be all doing a parkrun, it will be great if you could join us.

If you have any questions please contact Damian at drcwalk2run@gmail.com

Email address *
1. Personal Details
First Name *
Your answer
Surname *
Your answer
Address *
Your answer
Postcode *
Your answer
Home Telephone Number *
Your answer
Mobile Telephone Number *
Your answer
Do you have a Facebook account? *
This is so we can share information about the weekly runs to the group
Next of Kin Name *
Person to call in case of emergency
Your answer
Next of Kin Telephone Number *
Your answer
2. Medical Information
Do you suffer from any of the following?
Please give details of above and advise of any other medical conditions that we should be made aware of.
Your answer
3. Relevant Experience
Have you done any running before *
Please give details of any previous running experience? *
Your answer
If you have done any running before approximately how many miles on average per week have you ran for the last 2 months? *
The answer to this question will help us determine your suitability for the Walk2Run 2017 Programme.
Your answer
Are you involved in any other form of physical exercise? *
If yes, please give details.
Your answer
Other Information
Where did you find out about the programme? *
Your answer
What would you like to get out of the programme? *
Required
4. Disclaimer
Running Group Leaders are qualified leaders and are willing to share their experience and enjoyment of the sport with me.

I confirm that I understand that my participation in this group is entirely at my own risk and I should consult my own doctor if suffering from any condition that might make running injurous to my health.

Electronic Signature *
By typing your name here and submitting the registration form, you are agreeing to the above disclaimer.
Your answer
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