Manchester United Zip Slide registration form

First name: * Surname: *
Gender: Choose Male Female *   Telephone number:    Email: * Confirm email: *   Date of Birth: format dd/mm/yyyy *

Please note that this event is only suitable to anybody over the age of 12 and anyone under 16 must be accompanied by a parent or guardian.
Do you or anyone in your group have a medical condition or disability? Choose Yes No * Please give details:

On the day, you will have to travel up a number of flights of stairs to reach the launch site. You will be harnessed in around your legs and waist and travel up to speeds of 25mph before being stopped manually with two braking lines attached to your wire. If you have a medical condition such as a neck or back injury or disability that may affect your participation in this event, please contact The Christie Sporting Events Team before registering so we can discuss whether this event is suitable for you. If you do have a medical condition or disability you must consult your GP prior to registering.

Please note there is a weight limit of 6 stone minimum and 17.5 stone maximum

Would you like a free T Shirt:? NoYes Size: Choose Small Medium Large Extra Large Please state your preferred slide slot: (Your slide will take approximately half an hour) Choose Morning (9:30am - 12:30pm) Afternoon (1:30pm - 4:30pm) *

Would you like to take part at the same time as someone else who has already registered with The Christie? Please provide their name below?

Friends name: Do you have a personal motivation for doing this challenge How did you hear about supporting The Christie at this event?: Please select The Christie website Facebook Twitter Other website Previous Participant Visitor to The Christie Poster/Flyer Banner E-newsletter Successes Other Christie Mailing Employer Word of Mouth Rock Radio Salford Advertiser Other newspaper Other *

Emergency contact details

Emergency contact name: * Contact phone number: *

Declaration and terms and conditions

Participants must be aged 12 years or over. Anyone under the age of 16 must be accompanied by a parent or guardian. Participants must weigh no less than 6 stone and no more than 17.5 stone. The Christie charity, MUFC and Zip Slides UK (the event organisers) accept no responsibility for any injury or loss of belongings incurred whilst undertaking the challenge

If necessary you should gain advice from your GP as to whether you are physically prepared to undertake the challenge. You will be asked to sign an indemnity form on the day in order to participate. The entry fee is non-refundable and non-transferable. In the event of Zip Slides UK cancelling due to bad weather or unforeseen circumstances the booking fee is non-transferable between events.

The Christie charity accepts no responsibility for any costs incurred by participants for cancelled/rescheduled events. Photographs will be taken of participants throughout the day for use on promotional materials.

I have read and agree to the terms and conditions. Please select Yes * *