Wycombe Junior Parkrun

Thank you for taking the time to complete this form. The information provided will only be used as part of the Active Bucks project and not shared with third parties. This information will help with the evaluation of the project and increase the chances of future funding opportunities across the county.

If you have any questions about this form then please contact kirsty.mccoubrey@active-in.co.uk

Please complete the form on behalf of your child who has taken part in the Wycombe Junior parkrun.

What is your child's full name?

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* 1. What is your child's full name?

Please tell us your child's date of birth

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* 2. Please tell us your child's date of birth

Date
Please tell us your child's gender

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* 3. Please tell us your child's gender

What is your postcode?

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* 4. What is your postcode?

Does your child have a disability or long term health condition?

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* 5. Does your child have a disability or long term health condition?

Please describe your child's ethnicity

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* 6. Please describe your child's ethnicity

In the last 7 days, how much moderate intensity activity has your child completed in total?

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* 7. In the last 7 days, how much moderate intensity activity has your child completed in total?

In the past 7 days on how many occasions has your child completed a total of 30 minutes or more of physical activity?

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* 8. In the past 7 days on how many occasions has your child completed a total of 30 minutes or more of physical activity?

Please enter your email address

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* 9. Please enter your email address

Thank you for taking the time to complete this form, your help is very much appreciated.

For more information on the Active Bucks project please visit; www.activebucks.co.uk.

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