Hope Against Cancer Research

Challenge The Wild June 2026

Company*

First name*

Last Name*

Address*

City/Town*

Postcode*

Email*

Phone*

Date of Birth*

Name of GP/Surgery*

GP phone number*

Surgery Address*

Do you suffer from any of the following conditions – diabetes, asthma, migraine, epilepsy, chest pains, dizziness, joint problems, high or low blood pressure, or other illness?*

Are you allergic to any medications or foods (e.g. antibiotics, penicillin, elastoplasts, aspirin or any such medicines, any particular food etc.)?*

Are you receiving any medical treatment or are you on prescribed medication at present?*

Do you have any disabilities/impairments (e.g. physical, learning or behavioural, hearing or visual that may stop you from carrying out any activity?*

For water based activities, are you confident to be in water?*

Is there any other relevant information (medical or otherwise) that we need to be aware of?*

Next Of Kin Name*

Next Of Kin Relationship*

Next Of Kin Phone Number*

Please confirm that you agree that any photographs or video images taken of the event may be used for promotional purposes.*

Please detail any special dietary requirements*

We would like to include you in a WhatsApp group relating to the Challenge The Wild event. Do you give your permission for this?*

and finally, what size hoodie would you like*

Free Text

Entry fees

There is an entry fee of £250 per person which will be invoiced upon receipt of this form. This will be due for immediate payment and places are not reserved until full payment is received.

Fundraising

All fundraising money - £350 minimum will be received by Hope Against Cancer no later than 2 weeks after the event. If this is less than £350 I agree to pay the balance of the £350 fundraised amount.

If completing this form on behalf of your employer they understand that any shortfall of fundraising needs to be covered.

DISCLAIMER

Photographs

I agree that any photographs or video images taken may be used for promotional purposes. Please state 'No' if you do not give your permission.

Personal Accident and Travel Insurance

All participants must have their own personal travel insurance which is sufficient to cover the types of activities being undertaken as part of the event. Hope Against Cancer accepts no liability for personal injury or the loss of, or damage to, personal possessions.

Declaration

I have read the information provided and understand the nature of the event, and agree to myself participating in the activities provided by Challenge The Wild. I understand that, although risk is managed and minimised by the use of experienced and qualified staff under strict safety guidelines, there is a personal risk inherent in all activities which cannot be entirely eliminated and I understand and accept this risk.

I agree to myself taking part in adventurous activities which form part of this event. I understand that I will be expected to comply with instructions relating to group safety and social welfare and that any decisions made by the team leader are final.

In the event of serious illness or injury during this Challenge The Wild I agree to the disclosure of the information provided above and receiving medication as instructed and any urgent dental, medical or surgical treatment including anaesthetic or blood transfusion, as considered necessary by the medical authorities present.

I confirm that I have checked that my vaccinations and inoculations will be up to date in time for the event.

Submission of this form confirms your understanding of, and agreement to, the above.

Challenge The Wild June 2026

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