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Active You - Strength & Balance for Caring Registration Form

To access the free Strength and Balance for Caring sessions please register using this form

1.Do you currently have have caring responsibilities? (i.e. do you provide regular, unpaid care and support to a family member, friend, or neighbour who is unable to cope without your help due to illness, disability, mental health problems, or addiction? This care is not part of a paid job or formal volunteering)(Required.)
2.Are you currently registered with WIRED as a carer?(Required.)
3.How many hours per week do you spend on your caring responsibilities?(Required.)
4.Do you currently have a physical and/or health condition or illness that has lasted or is expected to last 12 months or more?(Required.)
5.Have you experienced any falls within the past 12 months?(Required.)
6.If you have experienced any falls within the last 12 months please tell us how many (if you have not experienced any falls please enter the number zero)(Required.)
7.How physically active are you currently? In this question we are asking about "moderate" physical activity, which means moving your body in a way that increases your heart rate, makes you breathe faster and feel warmer, and you can still hold a short conversation (examples of activities might range from playing sport and attending gym classes to digging in the garden or doing active housework).(Required.)
8.Do you currently engaged in STRENGTH activities twice per week (As recommended for maintaining physical strength)?

(This could include things like lifting weights, yoga, resistance band exercises or body weight movements like squats or push ups)(Required.)
9.Do you currently engaged in BALANCE activities twice per week (As recommended for maintaining good balance and stability)?

(This could include things like Tai Chi, Yoga, Dancing, or exercises that improve stability like standing on one leg)(Required.)
10.Please tick any of the following activities you regularly partake in.(Required.)
11.What is your full name?(Required.)
12.What is your age?(Required.)
13.What is your gender? (please choose from drop-down menu)(Required.)
14.What is your employment status? (please choose from drop-down menu)(Required.)
15.What is your sexual orientation? (please choose from drop-down menu)(Required.)
16.What is your religion? (please choose from drop-down menu)(Required.)
17.What is your ethnicity? (please choose from drop-down menu)(Required.)
18.What is your home post code? (Why do we need this? - we need the post codes of everyone who attends the sessions so we can see what areas people come from - you will not able to be directly identified from your postcode as each individual postcode relates to more than one property/residence)(Required.)
19.What is your mobile phone number? (Why do we need this? - we need your mobile number in case we need to inform you of any changes to sessions and to keep you updated)(Required.)
20.What is your email address? (Why do we need this? - we need your email address so that we have a back up way to contact you if we can't reach you via your mobile number)(Required.)
21.Is there anything else you’d like to tell us? (optional)
22.Your data - In order for WIRED and Active Wirral to be able to use your data to inform the development of free strength and balance activities for people with caring responsibilities in Wirral we need you to confirm that you give the following consent by ticking all of the consents - if you do not tick all of the consents you will not be able to access the Strength and Balance for Caring programme(Required.)
If you are happy with your answers please click below to submit your registration form.


Important Information - When you click submit, you will be automatically re-directed to the Active Wirral account set up page.

On the Active Wirral account set up page if you don't currently have an Active Wirral Account please select "I'm new...and would like to sign up"

It will take you a couple of minutes to create an Active Wirral Account.

Once you have set this up, you will be able to use your Active Wirral account to book on to any Active You sessions and reserve your place.