CAR beginners course application form
Complete this form in addition to paying course fees to book a place on the course

*The course is only open to over 18's*

Email address *
First name *
Your answer
Surname *
Your answer
Address *
Your answer
Postcode *
Your answer
Phone number *
Your answer
Date of birth *
MM
/
DD
/
YYYY
Country of birth *
Your answer
Do you have any medical issues? (e.g epilepsy, asthma, diabetes, allergies etc). Do not leave blank – if there is no information write ‘None’. *
Your answer
Emergency contact name *
Your answer
Emergency contact phone number *
Your answer
Emergency contact name 2
Your answer
Emergency contact phone number 2
Your answer
Authorised persons acting on behalf of the Club may need to obtain urgent medical treatment whilst at training or a Club activity. *PLEASE TYPE YOUR NAME BELOW* to give consent to emergency treatment being given to the named athlete on this form by trained personnel. *
Your answer
Date and method payment? e.g. BACS, gave cash to coach etc *
Your answer
How did you hear about the CAR beginners course?
Your answer
Are you currently involved in any other form/s of exercise? *
If you are currently involved in any other form/s of exercise, what is it?
Your answer
Have you done any running before? *
If you have run before, when was it and what type of running was it?
Your answer
Run England Group Leaders are qualified leaders and are willing to share their experience and enjoyment of the sport with you. Please confirm that you understand that participation in this group is entirely at your own risk and you should consult your doctor if suffering from any condition that might make running an injury concern or a risk to your health. Please type your name in the box to agree to these terms. *
Your answer
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