Request edit access
FREEMOOVEMENT Registration form
Data collection for attendees.
Sign in to Google to save your progress. Learn more
Email *
Full Name *
Gender *
Post code *
Group Name *
Age *
If you consider yourself disabled or you have a health condition that would affect your ability to take part in freemoovement please let us know.
Do you consider yourself to have a disability? (e.g. a physical or mental impairment which has a substantial and long-term adverse effect on your ability to carry out normal day-to-day activities.) *
Employment status. *
Please supply any medical information that the coach/leader should be aware of (e.g. recent illness, condition, injury or prescribed medication) which may affect your ability to join in with the full range of activities in the session and what support/modifications are needed). Please also make the leader aware at the start of the session.
In the last 7 days.... what was the total number of minutes you spent doing a physical activity that raised your heart rate, made you sweat or made you out of breath? Please be honest as we really want to accurately understand how peoples active lifestyles may be changed as a result of attending our sessions. *
PAR - Q (Physical activity readiness questionnaire) Only tick if you have conditions listed below.
On the below scale how motivated are you to get active? *
Not at all motivated
Highly Motivated
What are your main reasons for joining a FREEMOOVEMENT session? *
Required
Do you know of any reason why you cannot take part in physical activity? *
Required
Are you happy for us to use your data anonymously to help support our funding applications? We want to provide our funders with evidence of attendance and growth to keep FREEMOOOVEMENT going from strength to strength. *
Are you happy for us to contact you with updates on groups and programme developments. We will never share this information with 3rd Parties.
Clear selection
Emergency contact details including: Name, contact number, relationship *
Next
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms