Feel Good Families sign up form

Name of Parent / guardian

Gender

Male
Female

Postcode

District area

Email Address

Number of children and ages

How did you find out about Feel Good Families ?

Please State Other

Thinking about YOUR activity levels over the last 7 days would you say you were:

Inactive – doing fewer than 30 minutes activity per week
Fairly active – doing 30 -149 minutes activity per week
Active – Doing at least 150 minutes activity per week

Thinking about your CHILD(RENS) activity levels over the last 7 days would you say they were:

Active every day (60 minutes or more every day)
Active across the week (an average of 60 minutes or more a day but not every day)
Fairly active (an average of 30-59 minutes a day)
Less active (less than an average of 30 minutes a day)

Does your family access Health start vouchers/Free school Meals?

Healthy start vouchers
Free school meals
None

Would you be interested in being part of a parent forum around activities and family services for Ashfield?

Yes
No

Consent for storing submitted data

Yes, I give permission to store and process my data and agree to the Privacy notice

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