Tell us your story!

Name of individual submitting the story

Is the story about yourself?

Yes

It's about my project/organisation

No, it's about someone else

Name of the individual/group your story is about

Name of Organisation

Email Address

Provide your contact number

Area you are based in

Why are you submitting your story?

I have been funded by Active Essex

A member of the communications team has asked me

I saw on the website/social media/newsletter

Which funding did you receive?

Name of project that was funded

Tell us a little bit about the individual or project.

You may want to cover the below points. Importance of physical activity, Role within the community, Impact on others, Setting, Organisations involved

How has physical activity impacted you/your participants?

How did you get here? Tell us the journey.

Did Active Essex offer support or funding? How has your relationships with Active Essex &/or the community developed?

What have you learnt?

Identify any barriers or enablers

Please supply a quote(s) to accompany your story

Please supply a photo or video to administration@activeessex.org and add a link to your website or social media below.

To comply with data protection legislation, we need your written consent to use your information (still/moving image, audio and words). We will keep and use your information, in the context in which it was taken, for five years. The data controller is Essex County Council. Your contact details are required so that you can be contacted should we need to. Please note, published images can be viewed throughout the world and not just in the United Kingdom where UK law applies. By ticking the box below and signing this form, you are giving your consent for Essex County Council and Active Essex to use the information in the following ways:

Active Essex broadcast channels such as websites, social media, e-newsletters, printed and electronic materials (flyers, leaflets, brochures, banners etc) and media releases, including national media.(Required)

Yes

No

To give your own consent, please print your name below.

To give parental/guardian consent for an individual or child under the age of 13, please print your name below.

Please note in relation to this use of your personal data you have the following rights. • To be informed • To correct any inaccurate data • To have the use of your data restricted •To access the data • To have your data deleted • To object to the use of your data Essex County Council fully complies with information legislation. If you would like the full details of how we use personal data, and the rights you have about its use, please go to www.essex.gov.uk/privacy You may withdraw consent at any time by emailing administration@activeessex.org and stating the reference number at the top of this form. Images and associated personal information will be held securely. Images of historical value may be held indefinitely in the public record. For more details, please go to our Privacy Notice at essex.gov.uk/privacy. For comments and complaints about the handling of your personal information you can write to our Business Support Team at administration@activeessex.org

Holly Adams

Grace Hilton

Activity Finder