Community Captain participant survey

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* 1. What is your age?

Under 25

25-39

40-59

60-79

80 or over

Prefer not to say

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* 2. How did you hear about the program?

Social media

Newspaper

Television

Word of mouth

Other (please specify)

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* 3. Do you currently engage in regular physical activity? (30 minutes or more per day for 5 days a week)

Yes

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* 4. If you currently engage in regular physical activities, answer the following questions.

How many days per week are you physically active?

Approximately how many minutes are you physically active each time?

How long have you been physically active at this level?

What activities do you do?

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* 5. If you are not currently physically active, how long has it been since you did regular physical activity? (30 minutes or more per day for 5 days a week)

Less than 6 months

More than 6 months but less than a year

More than one year but less than two years

More than two years but less than five years

More than 5 years but less than 10 years

More than 10 years

I have never been regularly physically active.

Other (please specify)

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* 6. After attending an Active SWV program I intend to:

Remain inactive and not think about becoming more active.

Will remain inactive but think about becoming more active.

Do some physical activity

Participate in regular physical activity (30 minutes or more a day for 5 days a week).

Make physical activity a habit in my daily life.

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* 7. Please check all that the reasons that apply that have kept you from being physically active.

Lack of time

Lack of encouragement/support/motivation

Lack of enjoyment

Unsafe environment

Injury/fear of injury

Illness

Other (please specify)

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* 8. What activity(s) were part of your Active SWV experience?

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* 9. Before participating in the Active SWV program, had you ever visited the program venue?

Yes

Don't know

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* 1. What is your age?

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* 2. How did you hear about the program?

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* 3. Do you currently engage in regular physical activity? (30 minutes or more per day for 5 days a week)

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* 4. If you currently engage in regular physical activities, answer the following questions.

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* 5. If you are not currently physically active, how long has it been since you did regular physical activity? (30 minutes or more per day for 5 days a week)

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* 6. After attending an Active SWV program I intend to:

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* 7. Please check all that the reasons that apply that have kept you from being physically active.

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* 8. What activity(s) were part of your Active SWV experience?

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* 9. Before participating in the Active SWV program, had you ever visited the program venue?

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* 10. How do you benefit from Active SWV programs?