My Virtual Challenge – Apply Sign Up Now Thank you for signing up to My Virtual Challenge. Please complete the form below to sign up and create a fundraising page with JustGiving to start your Virtual Challenge. First name Last name Address Address line 1 Address line 2 City County Postcode Email Address Mobile Age If you are under 16 years you must ask a parent or guardian to agree to your taking part. Please ask them to email us at [email protected] to confirm they are happy for you to participate. If you are under 16 years please continue to fill this form so that we have your details. However we cannot accept your sign up until we have your parent or guardian email confirmation. Yes, I’m over 16 years No, I’m under 16 years My Virtual Challenge activity Run Walk Cycle Other If you have clicked Other please tell us what your challenge will be Please tell us your distance – if applicable Please tell us how long you think your challenge will take Please tell us more about your challenge Certificate of Achievement and Get Kids Going! sports shirt* I would like you to send me my Certificate of Achievement and a Get Kids Going! sports shirt* when I have completed my challenge. Yes No Everyone who takes part in My Virtual Challenge for Get Kids Going! will receive a Certificate of Achievement. * I know that I must raise £200 or more for Get Kids Going! to qualify for a sports shirt. Get Kids Going! sports shirt I would like a sports shirt Please state size Extra small Small Medium Large Extra large My Fundraising I promise to set up a JustGiving page to help Get Kids Going! Yes No What I plan to raise for Get Kids Going! Please state amount below Terms and Conditions I agree to the Terms and Conditions of this event. Yes No Keep in touch By signing up to take part in the Get Kids Going! – My Virtual Challenge, you are consenting to receive emails about the My Virtual Challenge event and Get Kids Going! and to set up a JustGiving fundraising page in aid of Get Kids Going! As well as My Virtual Challenge communication, you can choose other ways you’d like to be contacted. How would you like to hear from us? We would like to send you information on Get Kids Going! and how we encourage disabled children to participate in sport and how you can help us to turn their dreams of playing sport into reality through fundraising, events and volunteering opportunities. Email Yes No Text Yes No Post Yes No Phone Yes No We take your privacy seriously and we will never sell or swap your details with third parties. You can tell us at any time to withdraw your consent by emailing us on [email protected]. Information on how we protect and use your personal data is set out in our privacy and cookies policy. Confirmation Now you’ve completed the sign up form for My Virtual Challenge, it’s time to get fundraising! Please submit your form below and we will email you a link to create your personalised JustGiving fundraising page, so everyone knows why you’re taking part.