Based on the answers you have provided you will be referred to the Aspire Health Referral programme.
Please enter your name and address details and complete the declaration below.
By selecting the agree box, I confirm that I that have read, understood to my full satisfaction and completed this questionnaire. I acknowledge that this physical activity clearance is valid for a maximum of 12 months from the date it is completed and becomes invalid if my condition changes. I also acknowledge that a Trustee (such as my employer, community/fitness centre, health care provider, or other designate) may retain a copy of this form for their records. In these instances, the Trustee will be required to adhere to local, national, and international guidelines regarding the storage of personal health information ensuring that they maintain the privacy of the information and do not misuse or wrongfully disclose such information. (For more information, please see our Transparency Notice
I understand the information provided is essential to my application and I consent that this information will be entered into a database and stored securely in accordance with the General Data Protection Regulations (GDPR - 2018) and Wakefield Council Policy. I agree to be contacted by letter, email, telephone and SMS text message.