Get Walking Keep Walking Registration

DIY Registration Form

Questions About you

These questions help us know a little bit more about you. We will not pass on your personal details to any other organisations. This information could help us get funding for future walking programmes.

Forename *

Surname

Gender

Phone

Address

Line 1
Line 2
Town
County
Postcode
Country

Age *

How would you describe your ethnic origin?

Are you fit to walk?

Most people can start walking with no risk to their health. However, all walkers walk at their own risk. Please answer the questions below by selecting yes or no.

Has your doctor ever said you have a heart condition?

Do you feel pain in your chest when you do physical activity?

In the past month have you have pain in your chest when you were NOT doing physical activity?

Do you have a bone or joint condition that could be made worse by a change in your physical activity?

Do you ever lose balance because of dizziness or ever lose conciousness?

I understand that if I answered YES to one or more of the above questions, I should seek medical advice before increasing my walking. *

I understand that I walk at my own risk *

How active are you?

We want to make sure our walking programmes help everyone become more active. We'd like to know how active you are at the moment.

In the past week tell us the number of days on which you have done a total of 30 minutes or more of activity, which was enough to make you breathe faster. (Activities may include sport, exercise, brisk walking or cycling but should not include housework or physical activity that is part of your job)

Ini the past week on how many days did you walk for at least 10 minutes at a time to go from place to place? This might include walking to the shope or to your place of work.

How much time did you normally spend on one of those days walking from place to place?

Not counting any walking you have mentioned already, during the past week on how many days did you walk for at least 10 minutes at a time in your leisure time?

How much time did you normally spend on one of those days walking on your leisure time?

Date protection and consent

How we keep and use the information you have provided: Your information will be help by the Ramblrs in accordance with the Data Protection Act 1998 and will be kept strictly confidential. All information provided in this and any other questionnaires will go into statistics and it will not be possible to identify your individual responses from any reports we publish. These statistics will be used to judge the effectiveness of the walking programmes. We may use your details to contact you at a later date to find out how helpful you found the programme and to send you our newsletter with hints and tipe on walking.

Please confirm you have read and understood the above statement. *