In conjunction with the Harborne Carnival

*Medals to all finishers*

Sunday 28 June 2009 Start: 9.45am (First Run).
Route: High Street, Harborne (approx 1K).

First Name:
Family Name:
Address:

Post Code:
Tel no:
School/Club:
Male or Female:
Date of Birth

Under 10’s on Under 12’s on Under 14’s & 16’s Family Fun
Age Groups 31 Aug / 1 Sept 31 Aug / 1 Sept on Walk, Jog or Run
2009 (7yrs on 2009 31 Aug / 1 Sept All ages
the day) 2009
Please tick the
appropriate
age group.
Start time: 9.45am 10.00am 10.15am 10.30am

Declaration:
I declare that my child is fit to take part and understand that they take part entirely at my own risk and I
accept that the organisers of the event will not be responsible for injury, illness or loss of property.
Emergency contact number:
Medical Issues we need to be
made aware of:
I am happy for my child’s photo to be used in YES NO
community and leisure promotions (please tick).
Parent / Guardians Date:
signature:

Entry Fees: Junior Runs £2.00 & Family Run £2.00 per family member (Cheques made payable to
Birmingham City Council). The entry fees will go towards the organisation of the event and a contribution to
the “Edgbaston Foundation” to fund community, sports and art projects.

Entry Forms to: Edgbaston Fun Run, Edgbaston Constituency, Harborne West, 326 High Street, Harborne,
B17 9PU. Fun Run information will be sent out two weeks before the event with instructions on marshalling
points and safety information. Please enclose a large SAE. Telephone 0121 464 1953

Entries limited to 500.

Harborne Carnival

Official Use:
Race no: Age Group: Cheque no: