Manwell Sign Up

Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Date Of Birth*

DayMonthYear
Date
Postcode*
We use this data to assist with reporting our charitable objectives
Where did you hear about MANWELL?*

Word of mouthSocial MediaSearch engineVolair
(Word of Mouth only) Who recommended MANWELL to you?

First NameLast Name

Height (CM)*
Weight (Kg)*
Your BMI is:
Although we understand that BMI has a number of flaws, it does help us try and point you to the correct football setup.
What MANWELL Football do you want to join?*

WELLbeing football @ Tiber Street, LiverpoolWeight Loss football @ Prescot
We think you may benefit from Monday Social Football @ Tiber Sports Centre

Based on what you have told us, our Tiber football option looks to be the best option for you. Younger, more agile players participate in this league, providing a friendly, more competitive game.
We think you may benefit from our Weight Loss Football @ Prescot Soccer Centre

Based on what you have told us, the weight loss football league looks to be the best fit for you! Here you can both improve your overall health and contribute to your teams season both on the field and on the scales! Some may be offered to participate in this league if they’re older or physically restricted players.

Do you have any medical issues that your team captains need to know about?*
If you do please could you let us know what needs to happen in case of emergency (ie: where you keep meds etc)
Emergency Contact Name*
Emergency Contact Number*
I am happy for MANWELL to use my data (in an anonymised form - ie: with any personally identifying information removed) to further the work of the organisation.*

Yes
Should be Empty:

We think you may benefit from Monday Social Football @ Tiber Sports Centre