OnTrack - Expression of Interest
Expression of Interest Only: Completing this form does not guarantee a place on the programme. It is used solely to register your interest. Any personal data you provide will be processed in accordance with the General Data Protection Regulation (GDPR) and will only be used for the purposes of administering this programme. Your information will not be shared with third parties without your consent unless required by law.
Name
First Name
Last Name
Address
Address
Address Line 2
Town
County
Eircode
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Section 2 – Tell Us About Yourself
I am currently in recovery.
I am supporting a family member or loved one in recovery.
I have been affected by someone else's addiction
I am looking to improve my overall health and wellbeing
Other
What interests you most about onTRACK?(Tick all that apply)
Recovery coaching
Family recovery support
Improving my fitness
Nutrition and healthy eating
Mental wellbeing
Building confidence
Reducing stress
Meeting new people
Creating healthier routines
Learning more about recovery
Other
What do you hope to gain from taking part?
How would you describe your current fitness level?
Beginner
Somewhat Active
Active
Very Active
Other
Are you comfortable taking part in light to moderate physical activity?
Yes
No
Not Sure
Do you have any injuries, health conditions or mobilityissues that we should be aware of before taking part?
The onTRACK programme works best when participants attend regularly and engage fully. If offered a place, I understand and agree to:
Attend the weekly recovery and wellbeing session
Attend the weekly fitness session
Attend a MINIMUM of 80% of programme sessions over the 12 weeks
Inform the team if I am unable to attend
Treat fellow participants , facilitators and partner venues with dignity and respect
Take an active role in my own health, wellbeing & recovery journey
IMPORTANT: I understand that this is an expression of interest only and does not guarantee me a place on the programme. I consent to The ARC Project and Connect Laois contacting me regarding the onTRACK programme. If offered a place, I understand that I may be asked to complete a more detailed registration, health screening and consent form before the programme begins. (If you need to disclose anything further, you may do so in the box below)
Submit
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