Test - Actif

General Enquiry

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Consent for storing submitted data

Yes, I give permission to store and process my data

Name

Contact Number

Email Address

Membership Number (if known/applicable)

Age of Birthday person

Date of interest

* Please enter your date of interest (Saturdays Only)

Dates of interest

Any special requirements

Your Enquiry

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Name of Participant

Name of referrer

Email address

Contact number

By completing this form you are in agreement that you have consent to share the above information and the Referee is not currently under any medical investigation.

Yes, I agree

Your health matters

<a href="https://www.actif.wales/community-activities/activities/your-health-matters-programme/1438">Health Matters Programme - Actif</a>

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Name of referee

Name of referrer

Email address

Contact number

Has your GP advised that you should not participate in activity until further notice?

Yes

Please provide more details

Your health matters

<a href="https://www.actif.wales/community-activities/activities/your-health-matters-programme/1438">Health Matters Programme - Actif</a>

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General Enquiry

Good boost health

Good boost public aspect

Team sports