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NERS Customer Information Form

This form should be completed by Exercise Referral staff when sending customer information to the Customer Services team.

Staff Details

Customer details

Please enter a number less than or equal to 999999999.
Please enter a number less than or equal to 9999999999999999.
Name(Required)
Date of Birth(Required)
Address(Required)

Subscription details

Subscription start date(Required)
Subscription end date(Required)
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    • ​Free tennis weekends coming to Caerphilly parks
      2 September 2026
    • Caerphilly leisure centres join breastfeeding welcome scheme
      2 September 2026
    • ​Cabinet visits Caerphilly Leisure and Wellbeing Hub to see progress
      11 August 2026
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