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Solihull Active registration form


To join this activity session, it is important that your instructor/leader has a good understanding of your health status and current activity levels. This form also acts as your agreement to exercise and understanding that you take part in activity at your own risk.

Your information will be held by Solihull MBC in accordance with the Data Protection Act.

By submitting your details via this form, you are confirming that you have read and understand the above statement and the data protection statement in the footer of this form. You are also confirming that the answers given to the questions below are correct to the best of your knowledge.

Activity Type

Participant Identity

Address

Contact

Demographic

Emergency Contact

Health History

About You

Marketing Information

Data Protection Statement:

Your information will be held by Solihull MBC in accordance with the Data Protection Act. For more details on how your information will be used, please visit our website: www.solihull.gov.uk/About-the-Council/Data-protection-FOI/dataprotection. The information will be used to evaluate activities organised, improve the effectiveness of services, and show funders that we offer value for money.

The details on this form are held on a central Solihull Active database, held securely by www.substance.net/views/ and input into a database, held securely by Everyone Active, which the Council has vetted for information security. This information is used to produce anonymous reports. Follow up questionnaires will be sent to you to evaluate the health benefits and monitor levels of physical activity. It is up to you if you wish to complete these and return them to us. The results of any analysis will be used to influence future project developments.

Your information may be shared with other council services and partner organisations to ensure our records are kept accurate and to help us to identify services or benefits you may be entitled to or interested in. We may also need to share your information for the prevention and detection of fraud and/or other crimes or as the law requires. If you have been referred onto one of our programmes by a health professional, summary information about your progress may be shared and sent back to the health professional/service that originally referred you (e.g. with your GP surgery or University Hospitals Birmingham NHS Foundation Trust). However, we won't share these details with anybody else.

Your agreement can be withdrawn, and your data removed at any time by contacting Solihull Active on 0121 704 8207 or email solihullactive@solihull.gov.uk