Your details
Anfield Abseil (£15 registration, £185 minimum Sponsorship)Jacob's Journey - Snowdon Challenge Event (£25 registration fee, £175 minimum sponsorship)Shark Dive (£50 registration fee, £400 minimum sponsorship)

Full name

Date of birth

Your email

Your contact number

Address line 1

Address line 2

Address line 3

Town

County

Country

Postcode

Where did you hear about The Movement Centre, and why have you chosen to support us?

I agree to raise the minimum sponsorship required for the event selected
I agree to raise minimum sponsorship
I agree to be added to a Whatsapp group for the event I am taking part in.
YesNo
I agree that all details provided are correct
I agree all details are correct
I am fit and well to take part in the event
YesNo
Medical details

By Filling in this form, you are agreeing for us to contact you via email or phone. Your entry to an event is subject to us receiving your entry fee if applicable. You may also need to fill in and sign a waiver for some of our events, and you may need medical sign off from your GP.