Mount Arlington Mayors Wellness Lifestyle Makeover Self-Challenge Question Title * 1. This exciting event involves no cost to participants or taxpapers.The Mayors Wellness Committee is made up of appointed volunteers from the community. If you wish to volunteer your time or expertise for any of our events please email us at mtawellness@mountarlingtonnj.org. Please note: The information you provide is entirely voluntary. Your answers will be anonymous and will help us to plan an exciting community event that aims to improve the health and quality of life of Mount Arlington Residents! *Completing this survey does not obligate you to participate. Let's get started with the first question....WHAT IS YOUR AGE? 18-20 21-30 31-40 41-50 51-60 61-70 71-80 Greater than 80 years Question Title * 2. Are you Male or Female? Male Female Question Title * 3. Do you or any children in your household participate in borough recreation programs? Yes No Question Title * 4. Are you interested in losing weight? Yes No Question Title * 5. In the past 12 months have you been told any of the following (you may choose more than one answer): You need to lose weight You have high blood pressure You have diabetes or pre-diabetes You have a heart disease You have a chronic illness None of the above I prefer not to answer Question Title * 6. Which of these physical activities interest you? Organized sports Walking Jogging Races (I.E., 3k/5k) Group Exercise classes Strength Training Yoga/Pilates Cycling Hiking Swimming Other (please specify) Question Title * 7. Would you participate in a fun and informative 12-week community event which will allow you to meet your individual fitness and health goals with the guidance of a public health nurse and educator and fitness and wellness volunteers? Yes No Maybe Question Title * 8. Do you have access to a computer? Yes No Question Title * 9. Do you use a smart phone? (A phone that provides access to the internet and use of applications?) Yes No Question Title * 10. If you are interested in leaving your contact information on this form you may do so here. If you want your survey to remain anonymous but would like to be contacted by the Mayors Wellness Committee for more information please send a message to mtawellness@mountarlingtonnj.org. Learn about the Mount Arlington Mayors Wellness Committee at http://mountarlingtonnj.org/commissions/wellness-committee. There is a link to our email on the Borough page. Thank you for your time! Done