Get Active in Nature Registration Form

WELLNESS WALKS

Step into nature and feel the difference with our uplifting wellness walk and exercise classes.

In a friendly, supportive group, you’ll enjoy a gentle outdoor session that blends walking with simple balance, flexibility and strength exercises to help you move with greater ease.

Using specialist poles and Total Body Walking techniques, we’ll work on improving gait, core stability and confidence on varied surfaces—so you can walk taller, steadier and more comfortably, while soaking up the benefits of fresh air, movement and great company.

Name

First NameLast Name

Postcode

Phone Number

Phone

Email

example@example.com

Age

Gender

How did you hear about Get Active in Nature?

Which group(s) would you like to join?

Rows	Please select
Discovery Session 3rd November 2pm, Garden of Arden, CV37 0JA
Monday 11am Local Nature Reserve back of Leisure Centre, CV36 0NP
Monday 2pm at Ellen Badger Hospital, Shipston on Stour, CV36 4AU
Tuesday 9.45am Garden of Arden, CV37 0JA
Tuesday 2pm Garden of Arden, CV37 0JA

Initial assessment

Rows	Never	Rarely	Sometimes	Lots
Feel confident in doing exercise outdoors in nature
Experience an improvement in my balance and mobility
Exercise at least once a week for an hour or more
Enjoy taking part in new and stretching activities
Can report and improvement in energy levels or stamina
Feel a sense of belonging with a group of like minded people

Employment status

What would you like to gain from Get Active in Nature

How can we best support your aims?

Any other comments?

Ethnicity (as categorised by NHS Data)

Do you consider yourself to have a disability or illness?

Learning difficulty, disabilities or health issues

Emergency contact details

First NameLast Name

Emergency contact phone

Area CodePhone Number

I give my consent to be photographed and/or filmed to be used in publicity materials and social media. In some cases images could be used for wider work we deliver through ourpartnerships with other charities, government agencies and businesses.

Signature