Parkinson's Football Sessions

Parkinson's Football Sessions

Haverfordwest County AFC are delighted to be introducing Parkinson's Football sessions. If you, or someone you know, might be interested, please fill out this form to express interest.
Full Name*

First NameLast Name
Email Address*
example@example.com
Phone Number*
Please enter a valid phone number.
Are you completing this form for yourself, or on behalf of someone else?*
What age group do you/they fall into?*
Please select your/their gender*
Please state your/their ethnicity *
Please state if you/they have a long-term illness or disability *
Please state your home postcode *
What is your/their current level of physical activity?*
What is your/their current level of mobility?*

can walk unassisteduses a walk aid occasionallyuses a walk aid regularlyrequires assistance from another personOther
Have you/they played football before?*
Would you/they be attending with a carer?*

Yes, who will support me/them on the pitchYes, but not to participatePotentiallyNo
Would you/they prefer a running or walking football structure? *
What benefits would you hope to gain from the sessions?*

Improved physical fitnessImproved mobilitySocial connectionsRoutine and structureLove of footballOther
What slots would suit you/them best?*

Weekday morningsWeekday afternoonsWeekday eveningsClick here to state your/their preferred times during the week
Are there any particular challenges or support needs we should consider?*
Would you/they be interested in volunteering, coaching, or helping run the sessions in any way?*
Where would you/they prefer to attend regular sessions?*

Ogi Bridge Meadow 3GLocal sports hallOther
Would you be interested in engaging in community activities post-session, such as a coffee & catch-up? *
Do you/they have any other comments, suggestions, or questions for us?*
Are you happy to be added to Haverfordwest County AFC's mailing list?*
Should be Empty: