If you would like to participate in the programme then please complete the form below, filling in all of your details.

After submitting, someone from your club of interest will be in touch with you to confirm your place on the session.

Women are more likely to have been treated for a mental health problem than men and about 10% of children have a mental health problem at any one time

Want to be our latest signing?

Please fill in your details below and we’ll get back to you

Step 1. Personal details

Email Phone Post

Which football club do you want to register your interest for?



A. About you

A1. I am:

Male Female Transgender

A2. I am aged:

A3. I describe my ethnicity as:

A4. Do you have any mental health issues?

(This means difficulties with your mental health that limit your day to day activities)

A5. Do you have any other long term illness, health problem or disability that limits your daily activities?

If yes, please specify

A6. Where did you hear about the project?

A7. The sessions will be run in English. However, if you’d like documentation in Welsh in future, please tick here:

B. About participating in the project

B1. Have you taken part in playing football within the last 4 weeks ending yesterday?

B2. If yes, how many times in the last four weeks have you taken part in playing football?

B3. Are you happy to take part in playing football during the project?

B4. If no to B3, why do you not want to be involved in playing football?

If other, please specify

B5. If no to B3, would you be prepared to participate in other activities like time keeping for example?

B6. If no to B5, why do you not want to be involved in participating in other activities?

If other, please specify