Walking Football - Parkinson's UK Community Wellbeing Programme

Parkinsons UK Community Wellbeing Project is a joint partnership pilot with Parkinsons UK and The Albion Foundation.  

The program will run with a vision of increased confidence and accessibility to further support locally community with Walking football programme

If you require further information, please contact: lauren.holden@albionfoundation.co.uk 

 

Online Registration Form

First name
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Surname
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Date of birth
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Gender
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Ethnicity
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Medical infomation or disability
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Contact email address
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Repeat email
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Contact phone number
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Will you be bringing a carer with you who will stay for the whole session?
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Address line 1
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Address line 2
Town/city
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County
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Postcode
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Country
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PAR-Q Questionnaire
Rate your confidence: 1 - very not confident, 10 - very confident
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Rate your mobility: 1 - limited mobility, 10 - satisfactory mobility
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What is your weight?
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Has your doctor said you ever you have a heart condition or high blood pressure?

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Do you feel pain in your chest at rest or with mild exercise?

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Do you often feel faint, have spells of dizziness or loss of consciousness?

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Do you have a bone, joint or spinal problem?

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Do you have any respiratory problems at rest or with mild exercise?

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Free registration
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Photo consent
Do you give consent to be photographed at the event/session to be used for future promotional materials?
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Additional questions
Have you booked with us before?
Where did you hear about us?

We want you to know exactly how our service works, why we need your registration details and how we will be protecting your data. Please state that you have read our Terms and Conditions, Data Protection, & Code of Conduct

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We'd love to send you the latest information and exclusive offers about The Albion Foundation and West Bromwich Albion Football Club by email, post and SMS. We'll always treat your personal details with the utmost care and will never sell or share them to other companies for marketing purposes

Please let us know if you would like us to contact you by selecting the option below

Statement / disclaimer

In light of government and NHS guidance regarding COVID-19, if the participant is displaying any of the following symptoms such as high temperature, new continuous cough or a sore throat & loss of taste or smell, we request that you notify The Albion Foundation in advance of the session by calling 0871 271 9840.
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