Notts Women Runners - Full Registration Form

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If you have any questions about the contents of this form, please contact us at nottswomenrunners@gmail.com. We can provide a paper copy of it on request at any of our sessions, just email us to let us know.

Many thanks

Sarah Horrigan-Fullard

First name *

Last name *

Date of birth *

YYYY

Venue *

Where do you mainly attend your beginners' sessions?

Colwick Beginners - 12/4/15 start

Colwick Improvers - 12/4/15 start

Bulwell Improvers - 13/4/15 start

Basford Beginners - 14/4/15 start

Wollaton Beginners - 26/4/15 start

Strelley - 29/4/15 start

Castle Boulevard - 30/4/15 start

Phoenix Park - 30/4/15 start

Gedling Beginners - 4/7/15 start

Demo group

House name / number

Address Line 1

Address Line 2

Town / City

Postcode *

Are you a Nottingham City Homes Tenant? *

Nottingham City Homes, Fit in the Community is a 3 year community sports project in partnership with Nottingham City Council which aims to get tenants and leaseholders more active by adapting games and sports to suit your needs, abilities and interests and bringing these activities to an area near you. There are a variety of opportunities to not only participate but volunteer in different sports within the City. Please speak to one of the Run Leaders if you would like to find out more information about the project.

Yes

Email address

Telephone *

Emergency contact *

Next of kin name and phone number

Health and Fitness

Do you have a disability? *

Yes

If you HAVE a disability, please provide brief details

Do you have any health considerations we ought to know about? *

Yes

If you HAVE any health considerations, please provide brief details

Do you suffer from any of the following?

Diabetes

Heart problems

Joint problems

High blood pressure

Asthma

Back pain

Previous injuries

Other:

Are you currently involved in any other form(s) of exercise? *

Yes

If you ARE involved in any other form(s) of exercise, what type and how often?

Have you done any running before? *

Yes

If you HAVE run before, what type and how often?

Consent for participation

Notts Women Runners Group Leaders are qualified leaders and are willing to share their experience and enjoyment of sport withme. I confirm that I understand that participation in this group is entirely at my own risk and should consult my own doctor if suffering from any condition that might make running injurious to health

Signed *

Enter your full name below as your electronic signature

Date

YYYY

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