Move It Program

Participant Registration

*Please note you are only required to complete this form once for the Move It Program*

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* 1. What is your full name?

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* 2. What Move It program/s are you attending?

Outdoor Fitness for Over 50s

PT by the Sea

Discovery Walks

Tai Chi Amongst the Trees

She Rides

BoxFit

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* 3. What is your gender? (Please answer if attending She Rides Program)

Female

Male

other

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* 4. What is your contact number?

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* 5. What is your email address

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* 6. Please provide an emergency contact – to be notified in the case of an emergency

Name

Relationship

Phone number

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* 7. What is your council area

City of Marion

City of Mitcham

City of Holdfast Bay

Other (please specify)

Please be aware that you will be added to a monthly e-newsletter which you can unsubscribe from at any time.
Group photos (no faces included) will be taken for program promotion. If you have any concerns please let the instructor or program coordinator know on the day.

Please continue to next page to complete the Pre Activity Questionnaire