HHUGS Zip Wire Challenge
First Name
Your answer
Surname
Your answer
Date of Birth
MM
/
DD
/
YYYY
Address
Your answer
City
Your answer
Postcode
Your answer
Phone Number
Your answer
E-Mail Address
Your answer
Emergency Contact First Name
Your answer
Emergency Contact Number
Your answer
Do you have any medical conditions or accessibility needs that could affect or impair your ability to take part? (This will be provided to the centre prior)
Your answer
If you have any food allergies or dietary requirements please state here:
Your answer
How much you aiming to raise?
I would like to join the Transport from?
I would like HHUGS to make a JustGiving page for me?
Please tick if you would NOT like to be added to a WhatsApp group with other participants to help you fundraise
What is your preferred method of contact?
How did you hear about the challenge?
Your answer
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