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1. Registration Form

Living Well UK are delivering well-being activities and sporting activities to Children, Young People, Families and Adults.  To register your interest for taking part in the activities please complete this form. The information we are asking for is for monitoring purposes only and will be only shared with our Consortium and The Funders / Partners.

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* 1. VENUE or SESSION YOU ARE ATTENDING

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* 2. Have you been to any of our sessions before today?

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* 3. If you have answered 'YES' to question 2 - Have those sessions been at this location or somewhere else?

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* 4. If you have been to more than 1 session on a regular basis please let us know how many sessions you have accessed to date

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* 5. Participant's Full Name or Initials

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* 6. Participant's D.O.B 

Date

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* 7. Participant's Age

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* 8. Participant's Ethnicity

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* 9. Participant's Gender

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* 10. Does the participant have a Disability

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* 11. Parent's / Carer's First Name

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* 12. Parent's / Carer's Surname

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* 13. CONTACT TEL NO - (yours or your parent / carer)

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* 14. CONTACT EMAIL ADDRESS (yours or your parent / carer)

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* 15. What area of the city does the participant live in?

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* 16. Postcode

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