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Westminster City Council

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ActiveWestminster Mark Provider Details Form

Please fill out the short form below to add your details as part of the ActiveWestminster Mark.

"*" indicates required fields

Full Name Organisation / Individual*

Full Name

Name of organisation or individual applying for an ActiveWestminster Mark.

Telephone*

For Public Display

Email*

For Public Display

Address*

Street Address Address Line 2 City Postcode

Website Address (if applicable)

Lead Contact Name*

Full Name

Lead Contact Job Tile / Role*

Lead Contact Telephone*

For Internal Use Only

Briefly what activities or sports does your club or organisation offer?*

Archery

Athletics

Badminton

Basketball

Boccia

Canoeing

Cricket

Cycling

Diving

Fencing

Football

Gymnastics

Hockey

Judo

Karate

Netball

Rowing

Rugby

Sailing

Squash

Swimming

Table Tennis

Tennis

Trampolining

Triathlon

Volleyball

Other

Please specify

Do you provide activities tailored specifically for the following low participation groups?*

Women & Girls

People with Disabilities

Over 50s

People from Global Majority Backgrounds

People with medical problems related to inactivity

People who live in socially or economically disadvantaged areas

Young people who are not surrently participating in physical activity

Other

Please specify

Roughly, how many different members/participants does your club work with in a year?*

Are you currently delivering sessions in Westminster?*

Yes

No

Write all the locations where the activities are delivered

Location Name	Address	Postcode	Actions

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