Registration Form

Home Registration Form

Consent Statement:
We require your personal information below in order to fulfil the registration requirements for this event. We will share this information with your chosen charity (if applicible and only if you are taking part in this event to raise awareness and funds on behalf of the charity) so they can contact you regarding the event and fundraising.
In addition, we would like to use the details you provide to keep you updated about our services. Chapeau Events Ltd will only communicate with you in the way you choose and will always respect your privacy.
Privacy Policy – For further details on how we use the information you provide to us, please see our Privacy Policy.
Terms & Conditions – For full terms of event participation please see our T&Cs

Existing Customer?
- Yes
- No
Event
Title
First Name*
Surname*
Address
Postcode
Date of Birth
Phone Number*
Email*
How would you prefer to be contacted?
Sex
Height (cm)
Weight (KG)
Chest Size (for cycle jersey if applicable)
PASSPORT DETAILS (if event is outside UK)
Upload Passport Image?
Accepted file types: jpg, gif, png, pdf.
Full Name as shown on passport
Passport Number
Expiry Date
Issuing Country
Nationality
EMERGENCY CONTACT DETAILS (Next of Kin) Req'd for all events
Name
Phone Number
Relationship
INSURANCE DETAILS

(Please note: You need to provide travel insurance details if your event is outside the UK. You will not be allowed to participate without this. Please complete the details below or upload a copy of your valid insurance document. You can submit this at a later date if you haven't yet arranged it by sending to info@chapeauevents.co.uk. In addition, we would also recommend you apply for a EHIC card which is free and can be done via the following website; www.nhs.uk/ehic or at your local post office.
Upload Insurance Document?
Accepted file types: jpg, gif, png, pdf.
Name of Insurer
Policy Number
Emergency Contact/Claims Phone Number
MEDICAL INFORMATION

Have you ever suffered from any of the following conditions?
Heart problems
- Yes
- No
Blood Pressure Problems
- Yes
- No
Asthma, bronchitis or severe shortness of breath
- Yes
- No
Tendon, ligament or cartilage damage
- Yes
- No
Vertigo
- Yes
- No
Infectious disease
- Yes
- No
Eczema or skin problems
- Yes
- No
Diabetes
- Yes
- No
Epilepsy
- Yes
- No
Head Injuries
- Yes
- No
Cancer
- Yes
- No
Fractures or Broken Bones
- Yes
- No
Back Problems
- Yes
- No
Migraine or severe headaches
- Yes
- No
If you have said “yes” to any of the above conditions, please give details below:
Do you have any known allergies?
Are you currently taking any medication? (please specify the type and frequency and what it is used to treat)
Have you been hospitalised within the last two years? (please give details)
Have you ever suffered any psychiatric or mental illness?
Do you have any problems with sight, hearing or other senses? (please give details)
Are there any other medical issues you feel we should be aware of?
Do you have any special dietary requirements?
Do you have any other special requests, for example preferred rooming partner or single occupancy?
Where did you hear about us?
Please confirm if you are happy for photographs/video clips to be taken of you during the event.*
- Yes
- No
I agree that all information that I have given in this document and any other information provided to the Charity (if applicable) or Chapeau Events is complete and accurate to the best of my knowledge*
- I Agree
Please confirm if you are happy for Chapeau Events to contact you regarding future events.
- Email
- SMS
- Telephone
- Post
I hereby confirm that I have read and understood the Terms & Conditions of this event. (T&Cs can be located by clicking T&Cs Link at the top of this page)*
- Yes

X