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Active Vale - register
Please fill in the below to book a lesson
Your details
Name
*
Date of birth
*
Your age
*
Address
*
Postcode
*
Telephone number
*
Email address
*
Ethnic background
*
Please select
White British
Irish
Caribbean
African
Indian
Please select
White & Black Caribbean
Bangladeshi
White & Black
African White & Asian
Pakistani
Chinese
Are you registered disabled
*
Yes
No
Name of emergency contact
*
Emergency contact number
*
Relationship to attendee
*
Can we add your email address to our database so that you can receive more information for Active Vale
*
Yes
No
Please give information about any known medical problems or allergies?
*
Does this illness or disability or these illnesses or disabilities limit your activities in any way?
*
How much physical activity do you take part in per week?
*
0-20mins
20-40mins
40-60mins
60-80mins
80-100mins
100mins-120mins
120mins-140mins
160mins+
Which class are you enrolling for?
*
Please select from the list of classes
Beginners Running Childcare (Waddesdon)
Beginners Running Childcare (Wendover)
Girls Only Swimming (Booker Park)
Girls Only Swimming (Booker Park Beginners)
Girls Only Swimming (Booker Park Improvers)
Ladies Swimming Lessons (Aqua Vale)
Ladies Swimming Lessons (Stoke Mandeville)
Lunchtime HIIT sessions (Stoke Mandeville)
Taster Gym Classes (Stoke Mandeville)
Taster Gym Classes (Swan Pool)
Green Gym Sessions
Netball Now
Buggyfit - Ivinghoe Lawn
Buggyfit - Steeple Claydon recreation ground
Buggyfit - Wing Children’s Centre
Buggy Bootcamp – Bedgrove Park
Buggy Bootcamp – Fairford Leys football pitches
Buggy Bootcamp - Waddesdon Children’s Centre
Buggy Bootcamp - Wendover
Beginner running - Cuddington
Beginners running Great Brickhill
Beginners running Haddenham
Beginners running Waddesdon
Beginners running Wendover
Beginners running Winslow
Netball taster sessions - Aylesbury
Pilates - Fairford Leys
Self defence Aylesbury
Self defence Buckinhgham
If you are enrolling for Beginners running and require childcare, please let us know how many children and their ages.
Where did you hear about the project?
*
What physical activity sessions would you be interested in for the future?
*
What stops you from exercising?
*
Please select
Body image
Confidence
Culture
Time
Cost
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