Registration form
PLEASE COMPLETE THIS FORM IN BLOCK CAPITALS AS CLARITY IS ESSENTIAL WHEN MAKING FLIGHT BOOKINGS
PERSONAL DETAILS
INSURANCE
Do You have travel insurance*
Yes
No
Title
________________________________________________
*Travel insurance is mandatory. Clients are responsible for ensuring that they are in possession of private Travel Insurance with protection for the full duration of the event in respect of at least medical expenses, injury, death, repatriation, cancellation and curtailment (inc. flights), with adequate cover.
Name(s)
________________________________________________
Surname
________________________________________________
PARTICIPANT MEDICAL DECLARATION
Address
________________________________________________
I confirm that I am medically fit to participate in the IHF Camino Challenge 2026. I understand that I am responsible for informing UWalk.ie. of any medical conditions relevant to my participation, and that any pre-existing health issues must be disclosed to my travel insurance provider: Additionally, I agree to the UWalk.ie Terms & Conditions, noting that UWalk.ie is acting as an agent for Irish Hospice Foundation:
________________________________________________
Date of Birth (must be over 18) __________________________________
Yes
No
Sex (M/F)
________________________________________________
Phone (day)
________________________________________________
Yes
No
Phone (mob) ________________________________________________
EVENT TERMS, CONDITIONS & WAIVER I have read and agree to abide by the Terms and Conditions outlined in the accompanying event brochure, which I understand may be updated from time to time and posted on the website hospicefoundation.ie. In particular, I acknowledge and accept the terms of the Waiver at clause 26.
Email address ________________________________________________
NEXT OF KIN
Signed: __________________________________ Date: ________________
Title
________________________________________________
Name(s)
________________________________________________
Will you be returning with the group on 7 Oct 2026? Will you be travelling out with the group on 30 Sep 2026?
No
Yes
Surname
________________________________________________
Yes
No
Relationship ________________________________________________
If you are not returning with the group you must inform IHF before the 1st August 2026. If you are travelling separately from the group you are responsible for your own accommodation for the extra nights and your return flight home. We will be happy to provide you with the name and details of the relevant hotel.
Phone (day)
________________________________________________
Phone (mob) ________________________________________________
PLEASE NOTE:All accommodation will be shared Do you have a preference for who you wish to share with?
PASSPORT DETAILS
NB: Passport must be valid for 6 months after date of travel
PAYMENT DETAILS I enclose a cheque for the amount of €300 made payable to Irish Hospice Foundation Please charge €300 to my (Tick as appropriate) Card Number ___________________________________________________________________ Exp Date CVV No ___________________________________________________________________ Name on Card ___________________________________________________________________ Address Of Cardholder ___________________________________________________________________ VISA MASTERCARD Debit card Yes No Please specify name__________________________________ There are a limited number of rooms available at a supplementary cost of €335. If you wish to have a single room and are happy to pay this supplement please tick the following box. Yes I am happy to pay a single supplement of €335
Name (as on passport) _________________________________________ Passport Number _________________________________________ Expiry Date _________________________________________ Place of Issue _________________________________________ Date of Issue _________________________________________ Nationality _________________________________________
Country of Residence _________________________________________
Do you have any special dietary requirements?
Yes
No
If yes, please give details. Please note we can only cater for allergies
___________________________________________________________________
IHF Official Camino Challenge T-Shirt
Please see size chart and tick size req.
S M
L XL
XXL 3XL
4XL
Size
T-SHIRT SIZE CHART S
XL XXL HEIGHT cm 172 – 176 175 – 179 178 -182 181 – 185 184 – 188 187 -191 190 – 193 CHEST cm 92 -96 96 – 100 100 -104 104 -108 108 -112 112 – 116 116 -120 L M 3XL 4XL
___________________________________________________________________
Participation in this event is at the sole discretion of Irish Hospice Foundation. Please return your completed application form plus deposit to: Emma Rock, Irish Hospice Foundation, 32 Nassau St, Dublin. Emma is contactable at 01 679 3188 or fundraising@hospicefoundation.ie Registered Charity Number 20013554
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