Fall-proof: Share your story

Help inspire others and share your Fall-proof story to receive a prize worth up to £25.

We are hoping to learn from and share people's experiences of the Fall-proof exercises to help encourage others to be active.

Please fill in the form below and attach a picture or video of yourself doing an exercise from the Fall-proof strength and balance booklet to receive your choice of prize. Prize details can be found below.

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* 1. Tell us a bit about yourself, including your name.

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* 2. How do you like to keep active?

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* 3. How did you find out about the Fall-proof strength and balance exercises?

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* 4. Have you noticed any difference in yourself since you started doing the Fall-proof strength and balance exercises? If the answer is yes, please describe this in more detail below.

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* 5. Would you recommend Fall-proof to a friend?

Yes

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* 6. If you were to recommend Fall-proof to someone, what would you say?

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* 7. When do you do your Fall-proof exercises? e.g. while cooking dinner, on the phone, etc.

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* 8. Please upload a picture or short video of yourself doing one of the Fall-proof strength and balance exercises at home.

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

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* 9. Please tick the box below to confirm which prize option you would like to receive.

Option 1 – A support call with a specialised strength and balance instructor with tips on how to be more active and improve your strength and balance.

Option 2 – A £25 gift card to spend (e.g. Amazon, M&S, Love2Shop).

Option 3 – A set of exercise bands to support your strength and balance exercises at home.

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* 10. To make sure we are able to contact you regarding your choice of prize, please confirm your email address and/or telephone number below.

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* 11. Would you be happy for us to contact you about your story?

Yes

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* 12. Please tick the box below to confirm that you give your consent for the information you have provided about Fall-proof to be shared. For more information on how your information will be used, read our full Privacy policy here.

I consent to give my permission for my answers and photograph/video to be used for promotional purposes. By ticking this box, I understand that this content may be used in advertising, printed publications and on the Active Gloucestershire and 'we can move' website and on social media channels.

I understand that I can withdraw my consent at anytime by contacting info@activegloucestershire.org.

Thank you for taking the time to share your Fall-proof story. We will be in touch about your choice or prize. If you have any questions, please contact us at fallproofme@activegloucestershire.org.