July 2026: Thriving in the Summer: Health & Fitness Registration Form

July 25th, 2026

11:00am-12:30pm ET

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* 1. First Name

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* 2. Last Name

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* 3. Email

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* 4. Phone Number

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* 5. Age

Under 18

18-24

25-34

35-44

45-54

55-64

65-74

75 years or older

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* 6. Gender

Male

Female

Non-Binary

Prefer not to specify

Prefer to Self-Describe:

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* 7. Race/Ethnicity (please check all that apply)

Asian / Pacific Islander

Black or African American

Hispanic or Latinx

Native American or American Indigenous

White

Other Race

Prefer not to specify

Unknown/Undetermined

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* 8. City and State of Residence

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* 9. On a scale from 1 to 7, how knowledgeable are you about physical activity?

1-Not at all knowledgeable

4-Somewhat knowledgeable

7-Extremely knowledgeable

Not sure

1-Not at all knowledgeable

4-Somewhat knowledgeable

7-Extremely knowledgeable

Not sure

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* 10. On a scale from 1 to 7, how knowledgeable are you about heat safety?

1-Not at all knowledgeable

4-Somewhat knowledgeable

7-Extremely knowledgeable

Not sure

1-Not at all knowledgeable

4-Somewhat knowledgeable

7-Extremely knowledgeable

Not sure

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* 11. Are you interested in participating in this month's healthy challenge?

Yes

July 2026: Thriving in the Summer: Health & Fitness Registration Form

Question Title

* 1. First Name

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* 2. Last Name

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* 3. Email

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* 4. Phone Number

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* 5. Age

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* 6. Gender

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* 7. Race/Ethnicity (please check all that apply)

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* 8. City and State of Residence

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* 9. On a scale from 1 to 7, how knowledgeable are you about physical activity?

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* 10. On a scale from 1 to 7, how knowledgeable are you about heat safety?

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* 11. Are you interested in participating in this month's healthy challenge?

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* 12. If you would like to receive a wellness give-away, please provide an address where you would like us to send your items.