Healthy communities fund registration

Hurdles2hoops Registration Form

For football, art therapy and somatic therapy, please read carefully.
Name

First NameLast Name
Address*

Street Address

Street Address Line 2

CityPost Code

Borough
Ethnicity*
Date of birth *

MonthDayYear
Date
Gender*

MaleFemaleOther
Which activity are you registering for?*

Art TherapyCrochetSomatic TherapyFootballPilatesSoca ZumbaBoxingBasketball
Email Address *
If under 18 please provide parents email
Contact Number*
If under 18 please provide parents contact number
Disability*

In receipt of disability benefitsNot in receipt of disability benefitsIn receipt of universal creditPrefer not to say
Sexual Orientation*

HeterosexualPart of the LGBTQ+ communityPrefer not to say
What is your status in the UK?*

Asylum SeekerRefugeeOther
Employment Status*

EmployedSelf-employedUnemployed
What ward are you? *
Your ward is the area of your councillor and voting poll station, please do not insert your borough
Do you give us permission for photography?*

YesNo
By giving us consent to photography, a photo of you may be uploaded to our social media pages. In addition, we also may share with third parties and by signing you agree you have read and understand our policy below.
Signature*

Clear
If under 18 please provide parents signature
Should be Empty:

Hurdles2hoops Registration Form