Harlow Leisurezone ‘Charity-a-thon’ Registration Form
Harlow Leisurezone are staging a fantastic opportunity for local charities to come and use the
Leisurezone facilities and take part in a sponsored activity on Monday 26th August. For your charity to
be involved, please register your interest below. A member of the team at Leisurezone will be in
contact with you shortly.
Name of Contact:
Address of Charity:
Contact email:
Contact telephone number:
Charity Name:
Registered Charity Number:
What service does the charity provide for the local community?:
Who is the charity’s representative/organiser?
How many participants would you like to bring to the event?
Team Challenges
Please see the team challenges available overleaf. To enter all teams must be made up of 5
participants. Each charity can take part in one or all of the challenges, however they will run
simultaneously you will need a team for each event.
Dover to Calais Row
Enter a team of 5 to row from Dover to Calais in the quickest time. 2 heats 5 charities at a time, the
winning team will be the team with the quickest finish time overall.
London to Cambridge Cycle
Cycle London to Cambridge (60 miles) 5 bikes 1 hour slot quickest team to finish collectively wins.
The London Marathon
Collectively run the London marathon in 1 hour as a team of 5 participants.
Which team challenge(s) would your team like to undertake: _____________________________
Please turn over
Individual Challenges (All activities are subject to availability)
Facility space will be available on the day to complete individual challenges please see below a few ideas of
things we can assist with:
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Bounce-athon – to be done on trampettes – how many can you do?
Hula hoop spinning – How many can you do?
Step ups – how far can you climb?
Keepy uppies – how many can you do?
Themed or fancy dress exercise classes
Endurance exercises classes – how long can you do?
Assault courses
Triathlon
Endurance/distance swimming
In order to take part in one of these suggestions you will need to book a time slot advising of how many people
you will have attend this event on the day to take part in this challenge. If you have any further ideas or wish to
have a space to conduct your own event on the day please let us know.
Preferred time slot:
Number of participants:
Please select the equipment you plan to use for your challenge:
Gym:
Treadmill ⃝
Rower ⃝
Cross Trainer
Swimming Pool
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Fitness Studios (including Spinning studio)
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Tennis Hall
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Sports Arena
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Squash Courts
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Bike ⃝
There is a £5 registration fee per entrant for the team and individual events.
Eligibility-Terms &Conditions
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Your booking entry is only confirmed when you receive official confirmation from Leisurezone
Charities must check that all their participants will be raising money through sponsorship
All monies raised through sponsorship is the responsibility of the individual charity.
The money raised through sponsorship must benefit the people of Harlow
All Charities will need to officially declare the amount of money they have raised due to the event.
By entering this event you are agreeing that Harlow Leisurezone may use film or photography of the event in
publicity, and individuals are consenting to their images being used in marketing materials.
Signed:
Dated:
Please return the registration form by Wednesday 31st July 2013, to:
Deana Sears, Bookings Administrator, Harlow Leisurezone, Second Avenue, Harlow, Essex, CM20 3DT or by
email to info@harlowleisurezone.co.uk
For more information, please see our website:
www.harlowleisurezone.co.uk/events or call Deana on 01279 621502