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Walk like a Man sponsored walk Sunday 14 th June Worthing Seafront
registration form
First name......................................................Surname.....................................................
Address..............................................................................................................................
.........................................................................Postcode....................................................
Telephone No...................................................................................................................
Email...................................................................................................................................
I confirm that I am aged 16+
I confirm that I take part in the Walk Like a Man event at my own risk. I
hereby absolve Safe in Sussex and Worthing Borough Council from all liability
caused from an injury or damage in respect of any action brought by me or by
personal representatives in respect of participation in this event. My signature
also acknowledges my agreement that I may be videoed, audio recorded and
photographed during this event and that the images or recordings may be
modified for any and all uses, including but not limited to advertisements, social
media and marketing without any compensation and in perpetuity.
Signed.........................................................................Date.............................................
I agree that I am medically fit to take part in Walk Like a Man event
Emergency contact name.............................................................................................
Telephone number..........................................................................................................
Please send completed form to Louise Brooks, Safe in Sussex, PO Box 4127
Worthing, BN11 1AF
Wear some heels and show you are a real man!!