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2. Fill Your Park Prescription

   Congratulations on making the decision to improve your physical and mental health with outdoor activity!  Please fill out the following information so that we may help you on your journey.  By registering, you will receive our monthly Parks & Gardens newsletter, as well as, health information, tips, and activities.  Neither NHC Parks & Gardens nor the City of Wilmington Parks & Recreation will have access to any medical information from healthcare providers or other community partners by your participation in the program.

4. First Name*
5. Last Name*
7. Email*
8. Phone (optional)
9. Preferred Contact Method

   1. Email
   2. Phone
11. Who did you receive your Park Prescription from?
13. Prescription Details (prescribed activity(ies), frequency, etc.):
15. I am interested in (check all that apply)*

    1. Improving my health by using parks on my own
    2. Being contacted by a parks staff member to help connect me to healthy programs
    3. Receiving information regarding events and programs
16. In which part of New Hanover County do you live?*

    1. City of Wilmington
    2. Unincorporated New Hanover County
    3. Carolina or Kure Beach
    4. Castle Hayne
    5. Wrightsville Beach
    6. I do not live in New Hanover County
Leave This Blank:


18. 1. Receive an email copy of this form.
19. Email address

    This field is not part of the form submission.

20. Submit

* indicates a required field