Active Durham .

Register

Registration is currently open for the month of Walking/Running or Fitness only. All persons wishing to participate in the Active Durham activities who are under 18 years of age or vulnerable adults MUST complete and return the printable version of the form as participants can not be registered without parental consent. A Freepost address is detailed at the bottom of the form. For all other participants, complete your details and press submit and we will confirm your registration via email.

Download a printable version of the form.

Please note - registrations are open one month before each event so please re-visit this page in November to register for Indoor Sport

If you have any queries regarding the registration process please contact us at activedurham@durhamcity.gov.uk

Personal information:

Title:

Firstname:

Surname:

Date of birth and age:

Housenumber and Street:

Town:

Post Code:

Gender:

Contact Number:

Mobile Number:

Email Address:

Activity Attending:

Activity Date:

Ethnic Origin

White

British
Other

Black

British
Caribbean
African
Other

Mixed

White & Black Caribbean
White & Black African
White & Asian
Other

Other

Other Ethnic Group: Please State Below

Emergency Contact Details

Name of Contact:

Relationship to participant:

Daytime contact number:

Evening contact number:

Mobile Number:

Health Information

Have you taken part in any form of Sport or Physical Activity in the last 4 weeks?
Yes No

If you have done little exercise in the past, or you are returning to exercise following a period of inactivity, before starting an exercise programme you should seek advice from your GP

Do you consider yourself to have a disability?
Yes No

Please select disability type:

Not Applicable

Sight Impaired

Hearing Impaired

Mobility Impaired

Multiple Impairment

Learning Difficulties

Health / Other

Not Specified

Do you suffer from any other medical conditions?
Yes No

Do you smoke?
Yes No

General Information

DATA PROTECTION ACT 1998

The information you have provided will be held by the council on computerised and manual files within the Environment and Leisure Services department. The data may be disclosed to other departments within the council or other organisations, but only in order to ensure compliance with relevant legislation or for identification purposes or to prevent or detect fraud or a crime. If you wish to obtain a copy of the information the council holds about you, you must apply in writing to the Chief Executive, Durham City Council, 17 Claypath, Durham, DH1 1RH, a fee will be payable. City of Durham is a registered Data Controller in accordance with the Data Protection Act 1998.

PHOTOGRAPHY AND FILMING CONSENT

There may be situations in which films, photographs or images are taken of participants to promote Council activities. All films, photography or images will be produced in accordance with Child Protection guidelines and Safeguarding Young People and Vulnerable adults.

By submitting this form you consent to the Council conducting films and/or taking photographs or images whilst you, your child or person in your care is present.

If you do not wish to consent it is your responsibility to make contact with a member of staff when such a situation arises and assist in arrangements to ensure you are not part of any filming, photography or image.

Where the Council deem it appropriate to film, photograph or produce an image of participants those participants will be informed prior to it taking place. All persons will have the opportunity at that time to withdraw consent or refuse to participate.

LIABILITY

The Council's liability for personal injury, damage or death is limited to loss or damage incurred as a result of the negligence of the Council, its staff or agents. For the avoidance of doubt, the Council shall not be liable in contract, negligence, and breach of duty or in any other circumstances for any indirect or consequential loss.

How did you hear about Active Durham:

Would you like to be contacted about future Active Durham Activities?
Yes No

How would you prefer to be contacted? Please Tick

Telephone

Letter

SMS

I am choosing to submit this form on-line.
I have read, fully understand and agree with the 'General Information' contained on this form
.