Fitter Bits– Sign up Form

Please complete the details below. This will help us to make sure that we do our best to support your needs and help you to get the most out of the course.

Name
Address:
Phone No.
Email
How would you rate your reading skills? / I find it very difficult
There’s some things I find hard
I would like to brush up on my skills
I feel quite confident
I feel very confident
How confident are you at writing? / Not at all confident
A little confident
Quite confident
Very confident
How confident are you at using computers? / Not at all confident
A little confident
Quite confident
Very confident
What do you hope to get out of coming on the course? (Tick as many boxes as you like) / Lose weight
Improve fitness
To gain a qualification
Try something different
Social / fun
Increase confidence
Try new health and fitness apps
Other (give details)
You will get support from our tutors with all the activities that we do. However, you may feel you need some extra help.
What additional support, if any, will you need to come on the course?
From our tutors / Reading support
Writing support
A crèche
Help with using computers and technology
Any other help (give details)
From others (including key workers) / Someone to support you to come on your first day
Help getting to and from the group each week
Any other help (give details)
Please tell us about any additional support needs, disability or medical condition that we should be aware of. (e.g. do you need help with learning, mobility hearing etc?)
Please tell us about any allergies that you may have.
Key Worker Contact Details (if relevant)
Name
Organisation
Email
Phone No.

Thank you

DATA LABEL : PROTECT