Sign up for our Outsiders United Sports Teams by completing the Health Screening Questionnaire and Informed Consent form below. A member of the O’UTD coaching team will contact you to discuss your sign up and invite you to an information / induction day for your chosen group.
If you would like to meet with a member of our team to help fill in this form or discuss your health or support needs, please contact Nazir@lgbtiqoutside.org to make an appointment.
Sign in to Google to save your progress. Learn more
Phone number
Preferred method of contact
Date of birth
Which sport would you be most interested in joining?
Are you on any medication that may effect you during a session?
Clear selection
If you answered yes / unsure please give details
Do you have any illness or disability?
Clear selection
If you answered yes / unsure please give details
Do you have any injuries or joint problems?
Clear selection
If you answered yes / unsure please give details
Are there any conditions our Sports Coach should be aware of?
Clear selection
If you answered yes / unsure please give details
If you have answered yes to any of the questions above we suggest you seek medical advice to continue with training. Would you like to meet with our support worker to assist with this?
Clear selection
Do you need any additional support to access Outsiders United sports teams?
Informed Consent: I hereby state that I have read and understood and answered honestly the pre-exercise health screening questionnaire. I understand as with any exercise programme there is a risk of injury. I participate at my own free will and will agree to keep my instructor informed of any changes to my health that may impact my participation in this class. *
Would you like to attend our online information session on Saturday 5th February at 11am-midday?
Clear selection
Data Protection Notice: Information sharing & GDPRYou have rights as an individual which you can exercise under certain circumstances in relation to your Personal Data that we hold. These rights are to:•request access to your Personal Data (commonly known as a “data subject access request”) and request certain information in relation to its processing;•request rectification of your Personal Data;•request the erasure of your Personal Data;•request the restriction of processing of your PersonalData;•object to the processing of your Personal Data.You also have the right to receive your Personal Data in a structured, commonly used and machine-readable format and to have us transmit those Personal Data to another controller, if you have provided these Personal Data to us, if the processing is based on consent pursuant to point (a) of Article 6(1)of GDPR or point (a) of Article 9(2) of GDPR or on a contract pursuant to point (b) of Article 6(1) of GDPR and the processing is carried out by us by automated means, subject, however, to legal restrictions which may apply.If you want to exercise one of these rights please contact us at Carla.Ecola@LGBTIQoutside.orgYou also have the right to make a complaint at any time to the Information Commissioner’s Office (ICO), the UK supervisory authority for data protection issues, or, as the case may be, any other competent supervisory authority of an EU member state.Any references to the DPA should be removed as GDPR replaced the DPA. The policy should include who is responsible for notifying the ICO of any data breaches. This must take place within 72 hours of identification. By checking this box you confirm that you are happy to share personal information with The Outside Project and partner agencies where appropriate for the purposes of my support and safety. *
Clear form
Never submit passwords through Google Forms.
This form was created inside of lgbtiqoutside.org. Report Abuse