Bugando Medical Centre

PERSONAL INFORMATION:

Full Name

Phone

Gender

Age

Country

I am entering (choose one )

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Emergence contact information:

Name

Phone

Agreement:

Entry Confirmation: Medical history and fitness confirmation. By signing this form, you are confirming that, to the best of your knowledge, your general state of health and fitness is good. It is your responsibility to ensure that your health and fitness enables you to train and participate in this event. Bugando Marathon accepts no liability for your health and fitness during training and the race event.

Is health

Entry Confirmation: I understand that photographs may be taken during the event which may be used to publicise future events and content for Bugando Marathon.

Is photograph