Swim Serpentine Application Form - Chance for Childhood

Swim Serpentine 2020 – Apply

Use this form to apply for one of our charity places at Swim Serpentine or go back to the Swim Serpentine page. All of our places are for the 2-mile event.

Name
Title First Last
Date of Birth (DD/MM/YYYY)*
You must be aged 18 or over on the day of the race to enter
Telephone Number*
Email address*
Country of residence*
Have you taken part in this event, or a similar event, before?*
How much sponsorship money would you hope to raise?*
Please enter a number
What plans do you have to raise the minimum sponsorship target?*
Why have you chosen to support Chance for Childhood?*
Occupation
Employer
Does you employer offer matched funding?
- Yes
- No
- Unsure
How did you hear about Chance for Childhood's charity places?*
- Chance for Childhood website
- Twitter
- Facebook
- Email
Would you like to receive regular news from us by email?
- Yes, sign me up to your emails. I understand I can unsubscribe at any time.
Phone
This field is for validation purposes and should be left unchanged.