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ADDRESS:*

ADDRESS:

TOWN:*

COUNTY:*

POSTCODE:*

EMAIL:*

TELEPHONE:

MOBILE:

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Registration

How many people in your household?:*
Does anyone in your household, consider themselves to have a disability?
 
YOU
RESIDENT 2
RESIDENT 3
RESIDENT 4

 

Age Group:*
 
YOU
RESIDENT 2
RESIDENT 3
RESIDENT 4

5 - 11

12 - 15

16 - 19

20 - 29

30 - 39

40 - 49

50 - 64

65+

Gender?*
 
YOU
RESIDENT 2
RESIDENT 3
RESIDENT 4

Male

Female

How much sport and physical activity do you currently do?*
 
YOU
RESIDENT 2
RESIDENT 3
RESIDENT 4

< 30 Mins / Wk

30 Mins - 1 Hr / Wk

1 Hr - 2 Hrs / Wk

2 Hr - 3 Hrs / Wk

> 3 Hrs / Wk

When do you participate in sport and physical activity?*
 
YOU
RESIDENT 2
RESIDENT 3
RESIDENT 4

Day Time

Evenings

Weekends

After School

How far are you prepared to travel to participate in sport and physical activity?*
 
YOU
RESIDENT 2
RESIDENT 3
RESIDENT 4

< 1 mile

1 mile - 2 miles

2 miles - 3 miles

3 miles - 5 miles

5 miles - 10 miles

> 10 miles

What sports/Physical activities are you interested in:?*
 
YOU
RESIDENT 2
RESIDENT 3
RESIDENT 4

Aerobics

Aqua Aerobics

Archery

Athletics

Badminton

Basketball

Boccia

Bowls

Boxing

Canoeing

Cricket

Cycling

Dance

Diving

Dodgeball

Extreme Sports

Fencing

Football

Gardening

Golf

Gym

Hockey

Horse Riding

Ice Skating

Kayaking

LaCrosse

Martial Arts

Netball

Nordic Walking

Pilates

Rock Climbing

Rugby

Running

Sailing

Skateboarding

Skating

Skiing

Squash

Swimming

Table Tennis

Tai Chi

Tennis

Trampolining

Volleyball

Walking

Waterski

Windsurfing

Yoga

Other: 

Are you currently a member of a sports / physical activity club in the Three Rivers? If Yes , please name the club*
No
Yes
Name of Club:

Are you interested in sports volunteering?*
No
Yes

Are you interested in sports / physical activity coaching?*
No
Yes

Please tick the following box if you would like to be sent updates from the Three Rivers Sports Network when new sport and physical activity opportunities become available in the district.

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Please tick the following box if you agree to the information you have provided being passed on to Third Parties for further sport and physical activity marketing. All the information provided in this registration form will be stored by Three Rivers District Council.

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