To become a member of the walking club please complete the form below. We occasionally send emails relating to club events and news but you will never receive more than three a month. We will never pass your details on to third parties.

MileShyClub Walking Club Registration Form

Name

First Name

Last Name

Which walking group are you planning to attend?

What age range do you fall into?

Under 16's must be accompanied by an adult at all times

What is your gender identity?

What is your ethnicity?

Phone Number

Would you like to be added to our WhatsApp group chat?

Email Address

Your home postcode

Emergency Contact Name

We will contact this person in the event that you become unwell.

Emergency Contact Number

We ask the following questions to help understand and measure our social impact as a charity. Collating this information helps us demonstrate to future funders the success of our club so it’s really important to us and we’d be super grateful for just a moment of your time. We’ll be back in touch with you to ask them again in a few months, in the hope your answers will have improved! : On a scale of 1 to 5, how happy are you right now? (1 is very unhappy, 5 is very happy)

On a scale of 1 to 5, how active are you in your local community? ie: Do you take part in any other physical exercise or social groups, or do you volunteer? (1 is not active at all, 5 is very active)

How much time do you spend being active each week? (Being active means getting out of breath doing activity such as an exercise class, walking the dog briskly or gardening etc)

Is there anything else you'd like to let us know?

Do you have any health conditions - if so, please state below

Referrers Details (if applicable)

First Name

Last Name

Job title (if applicable)

Phone Number (if applicable)

Email (if applicable)