Mandatory Disclaimer Form - 5th November 2016, Littleton Manor Farm, Reigate

Runner Information

Runner First Name(*)
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Runner Last Name(*)
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Runner Email(*)
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Runner Date of Birth(*)
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Medical Declaration

The Reigate Rampage Run is an intensive obstacle run through challenging terrain, including mud, sand and water which will require high levels of physical excursion from all Runners.

Any Runner who suffers from any medical condition that may affect their ability to safely participate must withdraw now.

Any Runner who suffers from any other medical condition must declare this and any medication they are taking for that condition here and advise of where this medication is stored.

Pregnant Runners are advised not to participate without consulting their physician.

All information is treated with the strictest confidence and only made available to organisers and First Aiders.

Do you have a Medical Condition?(*)

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Medical Condition(*)
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Prescribed Medication(*)
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GP and Practice(*)
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Medicines are stored here(*)
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Next of Kin Information

Runners must advise The Company of their next of kin and by participating agree that The Company or their representatives may contact Runner’s next of kin in the event of an emergency.

Next of Kin(*)
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Relationship to Runner(*)
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Contact 1(*)
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Contact 2(*)
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Agreement to Participate


'The Competition' - this refers to the Reigate Rampage Run event described on the Company’s Website at

'The Company' - this refers to Reigate Rampage Run Ltd, registered office at The Granary, Brewer St, Bletchingley, Surrey RH1 4QP

'Runner' - this refers participants in the Reigate Rampage Run who have registered and paid their entrance fee via the Company’s website and who are over the age of eleven

Acknowledgement of Risk and Limitation on Liability

The Competition is an adventure run over obstacles, rough ground, through water in the open countryside and woods. By signing up to participate, the Runners are deemed to acknowledge that there may be a risk of injury by participating in the Competition. Many obstacles are of timber construction, competitors are advised that there may be a risk of splinters and finger entrapment and are advised to wear appropriate clothing to reduce these risks. The Rampage Run involves man made and natural water obstacles. The depth of water may vary due to weather conditions and water obstacles may involve deep water.

Runners are deemed to accept notice from the Company that, in consideration of the Company arranging access for the Runners to the land used in the Competition, the Runners agree to exempt the Company and any landowner from any liability in connection with the use of the land in the Competition.

The Company will ensure that first aid cover is provided for the Competition is supplied.

Each Runner acknowledges that he or she is responsible for his or her own safety (and the safety of his or her possessions) when carrying out the Competition. Each Runner understands that the Competition will be undertaken without direct supervision following the safety instruction.

In the unlikely event of an accident, or loss or damage to my personal effects, each Runner acknowledges that the Company will not be liable for any direct or indirect loss, damage or injury arising from or in connection with the Competition (except in instances of death or personal injury caused by the Company’s negligence) and each Runner waives all and any claims against the Company in this respect.

Each Runner confirms that he or she does not know of any medical condition that he or she suffers from which might have the effect of making it more likely that he or she is involved in an incident which could result in injury to him or herself or others.

Nothing in this document limits or excludes the Company’s liability for death or personal injury caused by the Company’s negligence, fraud or which cannot otherwise be excluded by applicable law or regulation

Agreement to Comply with Stewards Instructions

By entering the Competition you agree to immediately comply with any and all instructions of the Race Stewards, including but not limited to withdrawal from the Competition on the advice of First Aiders.

Certification of Fitness to Compete

Each Runner understands that the Competition requires a moderate level of fitness and is physically testing. Each Runner accepts that there is a risk of injury when undertaking such activities.

Agreement to image releases

,p>During the Competition, the Company will take both still photographic and moving video images of the event and Runners. By entering the competition you agree to release all your image rights in those still and video images and agree that the Company can use such images for the further promotion of the Company’s future competitions.

Submission of this form

By clicking the submit button below you are confirming that you are the Runner referred to in the first answer or, in the case of a 'Junior Runner' the parent/guardian of the Runner, and you are indicating your agreement to all the conditions laid out above.

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