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New Year New YOU

 

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Please ensure that you read the form carefully and complete ALL questions

Please note that there will be a registration fee of £25.00 payable at the nutritional workshop

 

I have read the Terms and Conditions and agree to adhere to them should my application be successful.

I agree to the Terms and Conditions
Sex

(By giving us your email address you are agreeing to us contacting you via this method)

Max 250 Characters
Max 250 Characters
Max 250 Characters
Max 250 Characters
Max 250 Characters
Max 250 Characters
Have you ever been diagnosed with or treated for an eating disorder?

Max 250 Characters
Max 250 Characters
Are you aware of any health reasons – or any other reasons – that might prevent you from doing or increasing the level of your physical activity?

Max 250 Characters
Have you had any operations in the last five years?

Max 250 Characters
Do you suffer from back pain?

Do you have any existing health conditions that will affect your ability to lose weight or exercise? (e.g, diabetes, asthma, epilepsy, bone/joint/back problems

Max 250 Characters
Do you suffer from any allergies or intolerances (e.g. wheat, dairy)

Do you have a heart condition?

Are you currently taking any prescription medication, including antidepressants?

Max 250 Characters
Are you pregnant, or do you have a child under six months old?

Max 250 Characters
Max 250 Characters
Max 250 Characters
Max 250 Characters

Please remind yourself of the Terms and Conditions before submitting your application.

Please Note:

  • To ensure that your application is considered, don't forget to email a photo of yourself to biggestloser@stfrancis.org.uk with your full name.
  • You can also include additional information about yourself to support your application when emailing your photo to us.

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