Physical Activity Sessions for NCL NHS and Social Care Staff

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At the Tottenham Hotspur Foundation we want our participants to have an enjoyable and safe experience with us. That's why it's very important for us to have clear and accurate information about people taking part. Please fill in the details below and take time to read the privacy notice and where we are asking for consent. 

For participants under 18, this form must be completed by a person with parental responsibility (legal authority) for them. 

PRIVACY NOTICE: This privacy notice tells you how we will use your information in line with the law and your rights. We collect personal information from you so that we can give you the services you have signed up for and to make sure that these services are run in a safe, fair and equal manner. We will keep your information secure and will not share data with anyone outside the Foundation unless requested by service providers and unless we are required to do so by law or to prevent abuse or harm. We will keep your personal information for the length of the course and a one year follow up period, after which we will anonymise so you can’t be identified any longer. 

If you have any queries please contact us on foundation@tottenhamhotspur.com.

PARTICIPANT INFORMATION
MEDICAL DETAILS



EMERGENCY CONTACTS
EMERGENCY CONTACT 1 EMERGENCY CONTACT 2
Name
Relationship to Participant
Mobile
Alternative phone number

Feedback: If you have any comments or suggestions about our services, 

please email us at foundation@tottenhamhotspur.com. 

By doing this we will be able to continually improve our service.   



Safeguarding is Fundamental to the success of all that we do.

Tottenham Hotspur is committed to safeguarding children and adults at risk


HEALTH QUESTIONS
1. Please select your top three motivating factors for joining the programme.
Reason 1 MOST significant to reason 3 LEAST significant.
Become more active Get fit Have more energy Live a healthier lifestyle Lose weight Feel more involved in your football club Be part of a social network



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PHYSICAL READINESS
If you have answered YES to one or more questions:

You should consult your doctor to clarify that it is safe for you to become physically active at this current time and in your current state of health.

If you have answered NO to all questions:

It is reasonably safe for you to participate in physical activity, gradually building up from your current ability level. A fitness appraisal can help determine your ability levels.
Note: This physical activity clearance is valid for a maximum of 12 months from the date it is completed and becomes invalid if your condition changes so that you would answer YES to any of the 7 questions.

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INTERNATIONAL PHYSICAL ACTIVITY QUESTIONNAIRE

We are interested in finding out about the kinds of physical activities that people do as part of their everyday lives. The questions will ask you about the time you spent being physically active in the last 7 days. Please answer each question even if you do not consider yourself to be an active person. Please think about the activities you do at work, as part of your house and yard work, to get from place to place, and in your spare time for recreation, exercise or sport. 

Think about all the vigorous activities that you did in the last 7 days. Vigorous physical activities refer to activities that take hard physical effort and make you breathe much harder than normal. Think only about those physical activities that you did for at least 10 minutes at a time.

Question 1

During the last 7 days, on how many days did you do vigorous physical activities like heavy lifting. digging, aerobics, or fast bicycling?

Question 2

How much time did you usually spend doing vigorous physical activities on one of those days?

Think about all the moderate activities that you did in the last 7 days. Moderate activities refer to activities that take moderate physical effort and make you breathe somewhat harder than normal. Think only about those physical activities that you did for at least 10 minutes at a time.

Question 3

During the last 7 days, on how many days did you do moderate physical activities like carrying light loads, bicycling at a regular pace, or doubles tennis?

Do not include walking.

Question 4

How much time did you usually spend doing moderate physical activities on one of those days?

Think about all the time you spent walking in the last 7 days. This includes at work and at home, walking to travel from place to place, and any other walking that you have done solely for recreation, sport, exercise, or leisure.

Question 5

During the last 7 days, on how many days did you walk for at least 10 minutes at a time?

Question 6

How much time did you usually spend walking on one of those days?

The last question is about the time you spent sitting on weekdays during the last 7 days. Include time spent at work, at home, while doing course work and during leisure time. This may include time spent sitting at a desk, visiting friends, reading, or sitting or lying down to watch television.

Question 7

How much time did you usually spend sitting on a week day?

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If you have recently taken any of the measurements below, could you please complete, if not this will be taken by our coaches if possible at the session.
PARTICIPANT MEASUREMENTS
     Pre
Height (cm)           
Weight (kg)
Waist (cm)  
Hip (cm)  
     Systolic      Diastolic
1st Blood Pressure
2nd Blood Pressure
3rd Blood Pressure

THIS IS THE END OF THE QUESTIONNAIRE. THANK YOU FOR PARTICIPATING. 


PLEASE CLICK THE SUBMIT BUTTON BELOW.