Mindful Movers participant health questionnaire.

DATE OF BIRTH

EMERGENCY CONTACT INFORMATION

This is the person we would notify in case of emergency

How can we contact you?

We promise we will not bombard you! Please tick all options that you are happy for us to contact you by:

Individual health information

This information will be kept confidential and secure and will only be available to staff involved in leading the group.

How did you hear about us?

PLEASE READ THE FOLLOWING

Photographs: We may use photos taken during sessions to promote the Mindful Movers group on our Facebook page and marketing materials.

Please tick if you are happy for us to use your image in our marketing.

Running Group and Walking Leaders are qualified, some are unqualified volunteers and are willing to share their experience and enjoyment of the sport with me. 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 exercise injurious to my health.

For Buggy runners / walkers: I understand that I am joining the group at my own risk and accept full responsibility for the health and safety of the infant(s) and any equipment I attend with.