Children’s Hospice South West Jonnys Mile Registration Form

1. Children’s Hospice South West Jonnys Mile Registration Form Name Age Home Address Home Tel No Name of Parent Parental Consent/ photo Parents Mobile No School Representing Mile Challenge Run /Walk /Row /Cycle /Swim(*) Date of Challenge (*) Please allow 3 visits to complete the swim mile challenge Please note all children under 18 must vacate the Pool Hall by 8pm and by accompanied by an adult at all times Tel St Mellion to plan your challenge – 01579 352022 I will bring this Registration Form to St Mellion International at the start of my Jonnys Mile Challenge. A Fitness Instructor will sign the challenge form to confirm the task has been completed. Upon presentation of my completed challenge form, sponsorship monies can be offered to my school before July 18th 2014

2. Children’s Hospice South West Jonnys Mile Challenge Form Name Age Home Tel No School Representing Mile Challenge Run /Walk /Row /Cycle /Swim(*) Date/s of Challenge (*) Please allow 6 visits to complete the swim mile challenge Instructor Signature Instructor Comments Tel St Mellion to plan your challenge – 01579 352022 Please note all children under 18 must vacate the Pool Hall by 8pm and by accompanied by an adult at all times I will bring this Challenge Form to St Mellion International along with my Registration Form at the beginning of my challenge. A Fitness Instructor will sign the challenge Form to verify the task has been completed. Please submit this form along with your Sponsorship form & monies to school before July 18th 2014. Thank you for doing your part to raise funds for Childrens Hospice South West.