Arthritis Foundation Participant Survey

Please complete all sections.

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1. Please select the Arthritis Foundation Program you participate in: (Required.)

Exercise Program (land)

Aquatics Program (water)

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2. Is this your first time taking an Arthritis Foundation Exercise Program class? (Required.)

Yes

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3. What is your gender? (Required.)

Female

Male

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4. In what year were you born? (enter 4-digit birth year; for example, 1976) (Required.)

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5. What is your City? (Required.)

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6. What is your State? (Required.)

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7. What is your ethnic background? (Required.)

Native American

Asian American

African American

Hispanic or Latino

White / Caucasian

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8. Do you have arthritis? (Required.)

Yes

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* 1. Please select the Arthritis Foundation Program you participate in: (Required.)

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* 2. Is this your first time taking an Arthritis Foundation Exercise Program class? (Required.)

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* 3. What is your gender? (Required.)

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* 4. In what year were you born? (enter 4-digit birth year; for example, 1976) (Required.)

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* 5. What is your City? (Required.)

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* 6. What is your State? (Required.)

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* 7. What is your ethnic background? (Required.)

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* 8. Do you have arthritis? (Required.)

1. Please select the Arthritis Foundation Program you participate in: (Required.)

2. Is this your first time taking an Arthritis Foundation Exercise Program class? (Required.)

3. What is your gender? (Required.)

4. In what year were you born? (enter 4-digit birth year; for example, 1976) (Required.)

5. What is your City? (Required.)

6. What is your State? (Required.)

7. What is your ethnic background? (Required.)

8. Do you have arthritis? (Required.)