2012 Mini Marathon Application Form

Kingston MiniMarathon 4K Race

Saturday 3 March 2012

10am-12noon

Bushy Park, near the Diana Fountain

Steps	Details
Step 1	Any athlete aged between 9 and 17 years is welcome to run. All athletes will receive a recorded time. Only athletes ages 11-17 years born between 22 April 2001 and 1 September 1994 and either living or schooling in the borough of Kingston will be eligible for selection to represent Kingston in the London Mini Marathon on Sunday 22 April 2012.
Step 2	Complete and return an application form by the closing date of: Friday 24 February 2012 For an application form: Email – Phone - Download – Complete Online
Step 3	On receipt of your application form, The Active Kingston Team will send full details of the Kingston Mini Marathon 4K Race.

Steps

Details

Step 1

Any athlete aged between 9 and 17 years is welcome to run.

All athletes will receive a recorded time.

Only athletes ages 11-17 years born between 22 April 2001 and 1 September 1994 and either living or schooling in the borough of Kingston will be eligible for selection to represent Kingston in the London Mini Marathon on Sunday 22 April 2012.

Step 2

Complete and return an application form by the closing date of: Friday 24 February 2012

For an application form: Email – Phone - Download – Complete Online

Step 3

On receipt of your application form, The Active Kingston Team will send full details of the Kingston Mini Marathon 4K Race.

For more information contact, The Active Kingston Team 0208 547 5006 or email sports.events@rbk.kingston.gov.uk

Forename: (*Required field)

Surname: (*Required field)

Gender:

Male
Female

Date of birth (dd/mm/yyyy): (*Required field)

Age:

Development (9 Years - 23/04/2011)

U13 (22/04/2001-01/09/1998)

U15 (31/08/1998-01/09/1996)

U17 (31/08/1996-01/09/1994)

Home Address (*Required field)

Postcode: (*Required field)

Email address - this is the main correspondence used (*Required field)

Name of Participant's School/College: (*Required field)

Athletes Club (if applicable):

Emergency Details

Please provide 2 emergency contact numbers

Home Telephone Number: (*Required field)

Mobile Number: (*Required field)

Medical Details

Does the participant suffer from any medical condition or disability that we should be made aware of?

Please select:

If 'Yes', please state:

Ethnicity (optional)

Ethnicity:

Please select...
White British
White Irish
White and Black African
White and Black Caribbean
White and Asian
Indian
Pakistani
Bangladeshi
Other Asian
Black Caribbean
Black African
Other Black
Chinese
Other mixed race
Other

I am aware that photographs may occasionally be taken by RBK staff for use in publicity material.

Please tick the box if you do not wish your photograph to be used in this way.

I give permission for my son/daughter to travel by coach, driven by an appropriately qualified driver for the vehicle.

Seat belts will be available and must be used by the athlete. Booster seats or any other aid will not be provided.

Parent/Guardian name

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