Register your Interest Registering your interest helps us plan programmes in your area and may be used to support funding and community delivery. About YouFirst Name *Last NameEmail Address *Phone NumberYour InterestWhich Programme(s) are you interested in? *Back on Skates (Adults)Family ProgrammeBack on Skates – 50+Which Programme(s) are you interested in?Preferred Location *BirminghamCoventryWolverhamptonDudleySandwellWalsallSolihullBromsgroveRedditchWyre ForestMalvern HillsWorcesterWychavonShropshireTelford and WrekinPostcode *PostcodePreferred Days/Times *Weekday MorningsWeekday AfternoonsWeekday EveningsWeekendsPreferred Days/TimesWhen did you last skate?NeverIn the last yearMore than a yearMore than 5 yearsMore than 10 yearsMore than 15 yearsMore than 20 yearsMore than 30 yearsMore than 40 yearsWhen did you last skate?What You Want to GainWhat would you most like to gain?Build ConfidenceImprove Balance and CoordinationStay ActiveTry Something NewMeet Other PeopleSupport my Child (Family Programme)Return to Something I Used To EnjoyImprove WellbeingOtherWhat would you like to improveBalanceConfidenceMobilityGeneral ActivityWhat would you like to improveAdditional InformationExperience LevelExperience LevelComplete BeginnerSome ExperienceReturning After a BreakDo you have an additional support needs we should be aware of?Would you be interested in subsidised or funded programmes if available?Would you be interested in subsidised or funded programmes if available?YesNoMaybeAge RangeAge Range18 - 3031 - 4950 - 6465+Child Age(s)3 years old4 years old5 years old6 years old7 years old8 years oldGDPR Consentconsent *I consent to my information being used to contact me about programmes and managed in line with the Privacy Policy.Funding/Data Use TransparencyI understand that anonymised information may be used to help plan programmes and support funding applications.Optional UpdatesI would like to receive updates about future programmes and opportunities.Submit
