Walkability Application Form

Walkability participant information form (Strictly confidential)

First name (required)

Last name (required)

Home telephone number

Mobile telephone number (required)

Address (required)

Post code (required)

Email address (required)

In case of emergency who would you like us to contact?

Name of emergency contact (required)

Relationship

Emergency contact Telephone number (required)

Please tell us about your walking ability

Please indicate any skills or experiences which might be useful to our project. You can also use this space to tell us why you would like possibly in the future to volunteer for walk leader training.

Is there anything we need to know about you? Especially health issues you think the walk leader should know

Meeting your needs

If you require additional support or equipment please tell us so that we can plan to meet your requirements. Are you on any medication? Is there anything that may restrict you from participating?

Please let us know what you would like to get out of participating in our walking group, Please tick all that apply:Better healthIncreased fitnessMeet new peopleExperience more areas of Pembrokeshire Coast National ParkBetter mental healthNavigation skillsExperience natureLearn about local historyGain confidenceOther (please give more information below)

Other

Which language would you prefer to communicate in? (required) ---EnglishCymraeg (Welsh)

Please tick the box below to confirm you are over 16I am over 16

What is your date of birth? (required)

I authorise Pembrokeshire Coast National Park Authority to process the information given in accordance with the Data Protection Act 1998 and General Data Protection Regulations.