JUST South Leicestershire

First Name*:

Second Name*:

What best describes your gender?*

Female (including transgender female) Male (including transgender male) Prefer to self-describe Prefer not to say

Age*:

Ethnicity*:

Disability*:

Are you pregnant or have you given birth in the last 12 months?*

Which District do you live in?*

Postcode*:

How did you hear about us?

Other:

Have you taken part in JUST before?*

Do you attend a class on the JUST timetable? (before JUST 2024 started)*:

In the past week, on how many days have you done a total of 30 minutes or more of physical activity, which was enough to raise your breathing rate?*

This may include sport, exercise and brisk walking or cycling for recreation or to get to and from places but should not include housework or physical activity that may be part of your job.

Over the past week, how may minutes/hours of physical activity have you done in total, which was enough to raise your breathing rate?*

This may include sport, exercise and brisk walking or cycling for recreation or to get to and from places but should not include housework or physical activity that may be part of your job.

In the past week, on how many days have you done exercises that strengthen your muscles?*

This refers to exercises that made your muscles feel some tension, shake or feel warm and that were carried out for 10 minutes or more.

Email*:

Phone Number*:

We'd love to keep in touch with you to give you updates about JUST. What is the best way for us to keep in touch?

Email Telephone SMS Text Add details for chosen contact method if not email above:

The personal information you supply to Blaby District Council and Harborough District Council in this form will be processed in accordance with the General Data Protection Regulation (GDPR) and the Data Protection Act 2018. We may share this information with other council departments, local authorities, government departments or law enforcement organisations to improve service delivery or for the prevention or detection of crime and fraud where the law allows this. Further information on how we handle your personal information can be found at https://www.blaby.gov.uk/your-council/data-security-and-access/data-protection-privacy-notice/ and https://www.harborough.gov.uk/privacy-notice.

I accept the T&Cs*:

Full terms & conditions can be found at https://www.justsouthleicestershire.co.uk/terms-and-conditions.

Yes

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