Move to include | Active Toolkit

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Nominating Individuals for Move to Include

Before you submit the nomination please read the following:

Nominations can be made for people with a disability or special educational needs.
the person needs to have an interest in being active and improving their health or reducing their isolation.
the person you are nominating is in agreement of the nomination.
the aim of our programme is to support individuals into a community sports club/active group so if they are already in one of these settings we would advise not to put a nomination in.
we don't provide transport for the individual to get to their chosen community provision, so they will need to have their own support with this or be able to walk/cycle if appropriate. However, SASP will look to attend up to 3 sessions with the individual to build their confidence and support the club understand their needs.

First name

Last name

Mobile number

Address

Post code

Date of birth

Medical Details (Please give details of allergies/injuries/health problems/emergency medications etc.)

Do you use any support strategies?

Do you have any communication needs?

Do you have any access requirements?

Do you have an interest in sports and physical activity? If so, what activities?

How active are you currently? (Please state average minutes of activity per week):

What would you like to achieve from the programme? E.g. make friends, become fitter, be part of my local community etc.

Can you travel independently or have transport available to them to access sessions?

What do the club need to do in order to you safe? eg. administer emergency medications/provide a quiet place/area

Nominated by

Interests/Hobbies/What brings you joy?

Preferred form of communication

Are you happy for relevant medical / disability information to be shared with the volunteer?

What activity would you like to do with a volunteer, anything specific?

If interested in Active Buddy are there preferred days/times to meet?

Do you have a preference for the type of volunteer? Age? Gender?

Consent for photographs