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
Which activity are you registering for?
Email Address
If under 18 please provide parents email
Contact Number
If under 18 please provide parents contact numberFormat: 0000 000 0000.
Disability
Sexual Orientation
What is your status in the UK?
Employment Status
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?
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

If under 18 please provide parents signature
Should be Empty:

Hurdles2hoops Registration Form