To register your family for The Family Mile, please complete this form with the details of the lead family member who will be the main point of contact for your family.

Details of other family members that you would like to register can be entered in section 12.

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* 1. First Name 

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* 2. Second Name

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* 3. Postcode

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* 4. Are you a Golding Homes tenant?

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* 5. Email Address 

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* 6. Mobile Number 

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* 7. Age

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* 8. Gender

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* 9. Ethnicity

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* 10. Do you or any other participating family members have a disability?

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* 11. Please enter names/ages/genders of all other participating family members

e.g. Joe/12/male

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* 12. Do you have any long term illness, health problems or disability that limits your daily activity?

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* 13. Do you ever feel pain in your heart/chest when doing physical activity?

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* 14. Do you suffer from dizziness causing you to fall or lose consciousness?

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* 15. Do you have a bone or joint condition that is aggravated by physical activity?

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* 16. Do you know of any medical reasons as to why you should not take part in physical activity?

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* 17. How did you find out about the Family Mile?

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* 18. Under the GDPR (data protection) act we need permission to share your data. Sports England, Brunel University and The Mason Foundation will only use/store your data for the purpose of monitoring & reporting on The Family Mile programme.

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* 19. Tick below to declare that all the above information is correct. You understand you may be asked to seek medical advice if answering yes to any of the questions. You must inform the Mason Mile of any changes in your health. You participate in the activity at your own risk.

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