Martin House | Fundraising | Event Volunteer Enquiry

Title *

Full Name *

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Date of Birth (dd/mm/yyyy) *

Full Address *

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Select type of event you wish to help with +

Centre Stage 2012 Heats, 16th- 20th April, Wardrobe Leeds
Anniversary Games, 22nd April, The Grammar School at Leeds
Leeds Half Marathon, 13th May, Leeds City Centre
Dragon Boat Race, 20th May at Roundhay Park
Jane Tomlinson's Leeds 10k Run, 8th July
Centre Stage 2012 Final, 17th July at O2 Academy Leeds
Jane Tomlinson's York 10K Run, 5th August
Jane Tomlinson's Walk For All, 19th August, Settle
The White Rose Centre various times and dates

T Shirt Size *

Personal Declaration *

I acknowledge that I am volunteering entirely at my own risk and that Martin House Children's Hospice shall not be liable in any way for any injury or loss that might occur as a result of my activities other than as a result of Martin House negligence
I agree that Martin House Children's Hospice may hold and use the data on this form for the database and futher volunteering opportunities.

Do you have any health problems or disabilities that we should be aware of? If yes please give details

Do you have any criminal convictions, if yes please give details