5 Swims for a Fiver Registration Form

Please fill in this form as much as you can. It helps GO Active, Get Healthy to secure more funding for activities like this one! 

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* 1. What centre would you like to redeem your 5 swims for a fiver voucher at?

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* 2. What is your Name?

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* 3. Are you...

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* 4. How old are you?

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* 5. What is your phone number?

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* 6. What is your email address?

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* 7. What is your ethnicity?

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* 8. In the past week, on how many days have you done a total of 30 minutes or more of physical activity which was enough to raise your breathing rate and break out in a sweat? (This may include sport, exercise and brisk walking or cycling for recreation or to get to and from places, but should not include housework or physical activity that may be part of your job)

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* 9. Which of the following conditions apply to you?

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* 10. Disclaimer. Please tick the box below to confirm that...

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* 11. For participants with one or more of the conditions listed in question 9. Please tick below to confirm that...

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* 12. We would like to be able to send you details of activities that might be of interest to you. Your contact details may also be retained by your instructor/coach/leader and used to contact you regarding the operation of the session you are attending. GO Active and Oxford City Council will also use your information for monitoring and evaluation in accordance with the General Data Protection Regulations 2018.

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* 13. In order to register your 5 swims for a fiver voucher at your local leisure centre we will need to share your contact details with a relevant Fusion Lifestyle instructor. Please tick here to confirm you are happy for your contact details to be shared with a relevant Fusion Lifestyle Instructor.

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