Move and Stretch - Registration Form

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To register to this programme, please fill out the form below.

Email *

First Name *

Surname *

Date of Birth *

YYYY

Age *

Address *

Post Code *

Mobile Phone *

Next to Kin: Contact Name *

Next to Kin: Contact Number *

Would you like to be added to our WhatsApp group to only receive messages from admin team about updates on the weekly sessions. *

Yes

Gender *

Male

Female

Non-binary

Identify in another way

Prefer not to say

Ethnicity *

White British

White European

Any other White background

Black / Black British African

Black / Black British Caribbean

Black / Black British Somali

Any other Black, Black British, or Caribbean background

Asian / Asian British Bangladeshi

Asian / Asian British Indian

Asian / Asian British Pakistani

Asian / Asian British Chinese

Any other Asian background

Any Other Group

Faith *

Christian

Buddhist

Hindu

Jewish

Muslim

Skih

Any other religion

Not known

No religion

Prefer not to say

Required

Sexual Orientation
*

Heterosexual or Straight

Gay or Lesbian

Bisexual

Other

Not known

Prefer not to say

Required

Are you a resident of Tower Hamlets? *

Yes

Required

Do you have a disability or special needs that we should be aware of? *

Tell us a bit about yourself, and why you’re interested in taking part in our fitness programme.

Are you currently participating in any other physical activity?

Yes

Required

How would you describe your mental and physical wellbeing before accessing this project.

Do you have a long term health condition?
*

Yes

Prefer not to say

Required

I consent to Trapped in Zone One using photographs and/or video recordings taken during the activities for the purposes of internally and externally promoting Trapped in Zone One. These images could be used in any media including print and digital media formats such as press/local paper, website, e-marketing, posters, promotional leaflets, banners, advertising, film and social media purposes. If you wish to discuss any matter further, please contact hello@trappedinzoneone.com *

I Agree

Required

Trapped Zone One is committed to processing information in accordance with the General Data Protection Regulation (GDPR). I give consent for my personal information to be used for the monitoring and evaluation purposes of this project. *

I Agree

Required

Would you like to join the Trapped in Zone One mailing list to receive weekly updates on the project? *

Yes

Required

A copy of your responses will be emailed to the address you provided.

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