Participant Registration Form

Get Out, Get Active Burdekin

The Get Out Get Active Burdekin program is aimed to support all Burdekin Shire community members aged 16 years and over to begin or continue their health and wellbeing journey. Council will partner with local organisations and activity providers to deliver an inclusive 8‑week health and fitness program designed to inspire active living and introduce participants to new ways to move. This program has been funded by Health and Wellbeing Queensland.

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* 1. Name:

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* 2. Age

16-24

25-34

35-44

45-54

55-64

65+

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* 3. What is your gender?

Female

Male

Prefer not to say

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* 4. Email:

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* 5. Best Contact Number:

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* 6. Address:

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* 7. How did you hear about us? Select all that apply.

Council Website

Council Facebook Page

Newspaper

Radio

Word of Mouth

Other (please specify)

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* 8. What is your current activity level?

Inactive (I do not currently excercise)

Moderately Active (1-2 hours exercise per week)

Active (2-3 hours exercise per week)

Very Active (more than 3 hours per week)

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* 9. Confirmation

I confirm I am 16 years or older, I will participate safely, follow reasonable instructions from providers, and seek medical advice if needed. I understand places are limited and preference will be given based on activity level to support community health outcomes. Allocation to activities depends on availability.

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* 10. I currently hold a gym membership.

Yes (please provide name of gym below).

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PROGRAM WILL COMMENCE WITH AN INFORMATION SESSION ON 11 MAY 2026
ACTIVITIES TO COMMENCE 18 MAY 2026 AND RUN FOR 8 WEEKS

<div style="text-align: center;">PROGRAM WILL COMMENCE WITH AN INFORMATION SESSION ON 11 MAY 2026<br>ACTIVITIES TO COMMENCE 18 MAY 2026 AND RUN FOR 8 WEEKS</div>

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* 11. What is your first preference for an activity provider

Brett Butler PT - Personal Training Studio

FC Caledonia - Highland Hijinks

Tiroana Collective - Chair Yoga

Next Point Coaching - Pickleball

Get Fit Home Hill - Gym Membership

The Burdekin Academy - Fit For Life

Silverlink Studio - Pilates

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* 12. What is your second preference for an activity provider

Brett Butler PT - Personal Training Studio

FC Caledonia - Highland Hijinks

Tiroana Collective - Chair Yoga

Next Point Coaching - Pickleball

Get Fit Home Hill - Gym Membership

The Burdekin Academy - Fit For Life

Silverlink Studio - Pilates

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* 13. Declaration

I declare that all information provided in this application is true and correct to the best of my knowledge. I acknowledge that submission of this application does not guarantee acceptance into the program and that acceptance is subject to eligibility criteria and assessment by the program organisers. I understand that providing false or misleading information may result in my application being declined or my participation being withdrawn.

Participant Registration Form

Get Out, Get Active Burdekin

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* 1. Name:

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* 2. Age

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* 3. What is your gender?

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* 4. Email:

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* 5. Best Contact Number:

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* 6. Address:

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* 7. How did you hear about us? Select all that apply.

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* 8. What is your current activity level?

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* 9. Confirmation

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* 10. I currently hold a gym membership.

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PROGRAM WILL COMMENCE WITH AN INFORMATION SESSION ON 11 MAY 2026ACTIVITIES TO COMMENCE 18 MAY 2026 AND RUN FOR 8 WEEKS

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* 11. What is your first preference for an activity provider

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* 12. What is your second preference for an activity provider

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* 13. Declaration

PROGRAM WILL COMMENCE WITH AN INFORMATION SESSION ON 11 MAY 2026
ACTIVITIES TO COMMENCE 18 MAY 2026 AND RUN FOR 8 WEEKS