Full Name:
Address:
Postcode:
Telephone Number:
Date of Birth:
If you are 18 or under, you will need to get a parent/guardian to sign the form on your behalf.
Email Address:
Social Media Addresses (if you have them):
Facebook:
Twitter:
Website:
Other:

Are you Registered Disabled, If yes, please can you give us some details as to your disability:
Please can you give us a short biography on yourself (Approximately 500 words – if you are filling this out by hand, please include an additional page for Biography):
Please highlight what sport you currently do (or would like to do with the assistance of a grant), including if you currently race and what level you race at.
What are your Long Term (1 year or more) and Short Term goals (less than 1 year) and how will a grant help you pursue your sport and achieve these goals?

Please highlight the details of your Grant Application including specific details and a breakdown of costs on what the Grant will be spent on, Costs and Suppliers if applicable – All successful applicants will be required to submit Receipts or Invoices before Grants will be paid.
If you Grant exceeds £500, please highlight how you are planning to fund the remaining amount:
Please give details of any other Grants or support you have received in the last 3 years:
Arctic One is only a small charity and we need support from all those who have received a grant to raise awareness of the Charity, the ‘Forward Motion Grant System and our Events in order to allow us to help any many people as possible in future years. Successful recipients will be required to help promote this through various media channels. Please highlight what you would be keen to do to help us in this way
(This can include Talks to local schools, Attending/participating in our events, Newspaper articles, Blog entries, Social Media or anything else you can think of!):

Please provide a Reference Name, address and Telephone Number:
What is your T-Shirt size for your Arctic One Technical T-Shirt

We have 5 Events throughout the year which cater for a wide range of abilities, ages and distances.
It would be great to see you some of the Events, particularly the Tri and Para Tri Festival or the
Junior Para Tri and we have included details regarding these events below. The other events (a 10 mile Run, a Duathlon and an Aquathlon) can be found on our Website (www.arctic1.co.uk). If you could let as many of your contacts know about the events as well, that would be much appreciated.
This event is in its 3 rd year and we are hoping to make it bigger and better this year and we would love to see more Para Athletes from all sports taking part in one of the races or as a relay.
There are Separate Para waves over all the triathlon distances as well as a Junior Para Duathlon and a
5/10km Run/Push. We are happy to help find relay teams or accommodate you if you are interested. Full
Entry is £20 per person for Para Athletes. www.entrycentral.com/Triandparatri
This event is in its 4 th year and is still the only event in the country exclusive to children aged 5-18 years with any form of disability. The event is completely Free and children are welcome to do as much or as little as they like including just one part or changing the distances to suit the individual. Any Children with a disability will be able to take part in some way and Siblings and Friends are invited too! www.entrycentral.com/juniorparatri