Participant First Name * |
Participant Last Name * |
Date of Birth * |
Gender * |
Address
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Email * |
Repeat email * |
Mobile Number
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Emergency Contact's Details |
Emergency Contact First Name * |
Emergency Contact Number * |
Ethnicity * |
How did you hear about this WWF activity?
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Has your doctor ever said you have a heart condition or high blood pressure?
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Do you feel pain in your chest at rest or with mild exercise?
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Do you often feel faint, have spells of dizziness or loss of consciousness?
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Do you have a bone, joint or spinal problem? (e.g. arthritis, osteoporosis, hip replacement)
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Do you have any respiratory problems at rest or with mild exercise? (e.g. shortness of breath, asthma)
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Have you had a stroke
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Do you have a mental health condition? (e.g. depression, anxiety, Alzheimer?s, dementia)
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Are you currently taking any prescribed medication?
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Do you have any other medical condition?
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Is there any other reason you should not take part in physical activity?
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Price Category * |
WWF Charitable Donation Financial donations help WWF achieve positive change within our local community. If you would like to make an additional financial contribution to assist us in the work we do it would be hugely appreciated.
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Would you like to make an additional donation to WWF..?
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We at Wycombe Wanderers Foundation would like to keep you up-to-date with the latest information, news and offers relevant to our WWF activities. This will only ever be done via email. |
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