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Eat Well Move More registration form

Eat Well Move More is a family healthy lifestyle service for children and their families.

Eligibility:

• Child aged between 4-16 years, and up to 25 years with additional needs,

• Who live/attend school/registered with a GP in the Solihull Metropolitan Borough,

• Where there are significant concerns about weight gain or diet/exercise,

• BMI is over the 91st centile.

Please note: This service is not suitable for children and young people with an eating disorder, please contact the TEDS team at Solar on 0121 301 2730.

To join this service it is important that our health trainers have a good understanding of your child's health status and current activity levels. This form also acts as your consent and agreement for your child/family to take part and understanding that taking part in activity is at your own risk.

Please complete this form on behalf of the child you are referring and submit online. One of our health trainers will be in touch within 5 working days of us receiving your completed registration form. Please note, if your child does not meet the eligibility criteria noted above we will be in touch to say that they unfortunately cannot join the programme.

Your information will be held in accordance with our Data Protection Statement. 

For more information on this programme visit - https://solihullonthemove.co.uk/get-support-to-be-active/families/eat-well-move-more/ 

Activity Type

Participant Identity

Address

Contact

Demographic

Medical Information

Emergency Contact

Marketing Information

Eat Well Move More

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

Please note: Once you click 'submit' below you will receive a thank you message, acknowledging successful submission of the form. If you don't see this message, it means that you have not answered one or more of the mandatory questions on the form. In this instance please fix the errors highlighted and then click 'submit' again.