First name
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Last name
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Date of birth
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Gender
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Address
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Email
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Repeat email
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Mobile number
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I would like to attend on...
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Emergency Contact Name
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Emergency Contact Number
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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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If yes, please state below...
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Is there any other reason you should not take part in physical activity?
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Coronavirus Disclaimer
It is of the upmost importance that we at Wycombe Wanderers Sports & Education Trust safeguard the health and wellbeing of all staff, participants and immediate families at/during our activities. Therefore, please answer the following honestly and truthfully to ensure the safety of all involved in our activities.
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Have you, or anyone in your immediate family, had or shown any symptoms of Covid-19 in the last 14 days? (Dry Cough, Tiredness or Fever?
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Photography Disclaimer
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May Wycombe Wanderers Sports & Education Trust use image(s) of the participant in printed publicity or promotional literature, to be produced by WWSET, including website stories, social media content, leaflets, posters, newsletters and other display material?
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Data Protection Disclaimer
The information you supply will be used by the Wycombe Wanderers Sports & Education Trust for administrative purposes within the terms of the Data Protection Act 1998. We shall not supply it to any third parties. Click here to go to be directed to the WWSET Privacy Policy.
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WWSET Charitable Donation
Financial donations help WWSET 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 WWSET..?
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Ethnicity
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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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