Walking Football Sign-up

Thank you for your interest in our Walking Football programme.

Sessions take place every Wednesday at 10-11am in Guildford (venue to be confirmed by email).

Name
Address
Email
Telephone / D.O.B

Health and safety

Do you have any existing health problems?

Are you on any medication?

Do you have any allergies?

Emergency Contact 1 / Emergency Contact 2
Name / Name
Relationship to you / Relationship to you
Telephone number / Telephone number

Using the gift aid scheme, Age UK Surrey can reclaim from the Inland Revenue 25p on every pound given as a donation. This helps your donation to Age UK Surrey go further and it won’t cost you any extra.

I wish Age UK Surrey to treat all qualifying gifts of money made

today in the past 4 years in the future

as Gift Aid donations. (Tick all boxes that apply)

I confirm I have paid or will pay an amount of Income Tax and/or Capital Gains Tax for each tax year

(6 Apri l - 5 April) that is at least equal to the amount of tax that all the charities or Community Amateur Sports clubs (CASCs) to which I donate will reclaim on my gifts for that tax year. I understand that other taxes such as VAT and Council Tax do not qualify. I understand the charity will reclaim 25p of tax on every £1 that I give on or after 6 April 2008.

Age UK Surrey accepts no responsibility for any individual participating in this activity.

I understand that participation in this activity is at my own risk.

Signed……………………………………………………… Date………………………………………..

Information is not shared with third parties but by completing this form you are agreeing to Age UK Surrey keeping information about you. We will also let you know about our products, services and special offers and opportunities. By providing your contact details you are agreeing to receive information unless you indicate otherwise by ticking this box [ ]. You may unsubscribe from our communications at any time.