Activage Project

ACTIVAGE is an EU funded project aiming to promote healthy and active lifestyles and reduce social isolation for over 65s through use of technology.

The criteria for involvement are that you are 65 or over and living in Leeds, and for the equipment to work you need to have broadband at home.  Your carers and family members can also be involved.

More information about the Activage project is available on this site 

If you participate in the project you will be contacted to arrange for the devices to be installed in your home. During the installation visit you will be shown how to use each device and given information about any support you might need in using the devices during the 12 month period. You can then simply use the devices for the time period. You may be contacted by the project team during the 12 month period to see how you are getting on.



Do you have any of the following at home? Please tick all that apply. *


You can add contacts of your choice to your ACTIVAGE account to view your activity and health information and you will be able to send alerts to. Do you have someone, friend or family, who you would like to add as a contact? *


Please provide name and contact number *


Does this person have access to the internet? *


Where would you place yourself on the scale below? Please tick the box. *

The information you provide on this form will only be used to assess your eligibility to participate in the Activage project, and to administer the project (including the installation of Activage equipment in your home).  Full details of how Leeds City Council will process your personal information are contained within the Privacy Statement.

Privacy Statement

1. Activage is an EU funded project which will be delivered by Samsung Electronics (UK) Limited in co-operation with Leeds City Council, the Swiss Centre for Electronics and Microtechnology (centre suisse d'electroniq et de microtechnique - CSEM) and the University of Surrey.

2. The data you provide on this form will be held by Leeds City Council in accordance with the Data Protection Act 1998.  The information you provide to the Council will only be used to assess your eligibility to participate in the Activage project, and to administer the installation of Activage equipment in your home.

3. Samsung will be responsible for all personal data collected by any equipment installed, and the Council will not have any access or control over this information (you will be required to provide your consent to Samsung separately during the installation process).

4. Samsung will share anonymised data collected from the project with CSEM and the University of Surrey.

5. The Council will not share the information you provide on this form with any third parties unless required by law.  If, however, you notify the Council that you no longer wish to participate in the Activage project, the Council will notify Samsung of this for administrative purposes (and vice-versa, should you inform Samsung that you no longer wish to participate).

6. The personal data you provide on this form will be held by the Council until 31st March 2021.

7. You also have the right to ask for access to any information we hold about you.  To do so, please contact

8. If, at any time, you wish to withdraw your consent to participate in the Activage project, you can contact  Leeds City Council will then arrange to collect the equipment installed in your home and will also advise Samsung that you no longer wish to participate in the project.  Both parties will then ensure that any personal information held is securely destroyed as soon as possible.


Please tick... *


Please tick... *


The full set of equipment we offer is:

1) Smart watch
2) Smart phone (Samsung A3)
3) Home sensors

There is more detail about this equipment here (insert link) including the recommended locations for Home Sensors.  You are encouraged to read this information prior to installation.

We recommend taking the full set of equipment.  You can opt out of any of the items (which are not mandatory) you do not want on the day of your install or at any time.

Mandatory items 
Door Sensors and Home Hub. 

Optional Items
Smart Watch, Smart Phone, Motion Sensors, Electric Appliance Sensors and Whole House Energy Monitor.


From the list below, is there any equipment you would like to opt out of? If so, could you please let us know why you do not want it. *


Have you registered on the ACTIVAGE website with your own personal email address? (We will provide you with a login at your installation if not). *


Any further comments or anything we should be aware of?


Are you going to be unavailable for a period of time over the next few weeks (e.g. on holiday)? Please tick below. *


Where did you hear about this project? *


Please sign and date below. PRINTED NAME accepted.


Places are limited. If you are chosen to participate in this project you will receive a call from our install team within x weeks to arrange an appointment.  Please allow 1-2 hours for your installation.