Wellness Programme Enrolment Form
Sign-up, goals, health flags, and consent for a workplace wellness programme.
6 questions · 1 page · about 3 minutes to answer · fully editable after you start
A wellness programme enrolment needs three things: what the participant wants out of it, anything the organisers must know for safety, and documented consent to take part. This form collects all three, with a date and drawn signature closing the consent – one submission per participant, complete and auditable.
The goals question does double duty: it personalises coaching and, aggregated, tells you which programme tracks (fitness, stress, nutrition, sleep) deserve the budget this cycle.
Template preview
This is a picture of every question as a respondent would see it, so nothing on it can be clicked or typed into. Use this template to get your own editable copy.
Opens in the Light theme, or in your own default theme if you have set one — change it anytime to any of the 4 built-in looks, or build your own on a paid plan.
Page 1
Join the programme
Thank you for your interest in the wellness programme. This form signs you up and tells us what you would like to get out of it. It takes about 3 minutes. This form is not an emergency service. If you need urgent medical help, call your local emergency number.
Q1.Full name and department*
Q2.What is your main goal for this programme?*
- Get fitter
- Manage stress
- Eat better
- Sleep better
- General health check
- Other…
Q3.Any health conditions or injuries the organisers should know about? (Write None if none.)*
Q4.Do you consent to taking part? Participation is voluntary.*
- I consent
- I do not consent
Q5.Date*
Q6.Signature*
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