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* 1. Please select your age:

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* 2. Please select your gender:

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* 3. Please select your ethnicity:

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* 4. Please enter your zipcode

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* 5. Does lack of internet access prohibit you from finding health resources online?

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* 6. How did you hear about Active SWV?

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* 7. Do have any of the following chronic health conditions:

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* 8. Since Covid-19 and stay at home orders, do you currently engage in regular physical activity? (30 minutes or more per day 5 days per week)

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* 9. If you currently engage in regular physical activity, please answer the following questions:

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* 10. If you are not currently active since Covid-19 and stay at home orders, how long is it since you were regularly physically active? (30 mins or more per day for 5 days a week)

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* 11. Did Covid-19 and stay at home orders have a direct effect on the amount of physical activity you did since the start of the pandemic? 

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* 12. Please check all that the reasons that have kept you from being physically active during the Covid 19 pandemic.

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* 13. On a scale of 1-10 (1 begin very willing and 10 not willing) how willing would you be to attend an Active SWV in-person program in the month of July?

0 10
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i We adjusted the number you entered based on the slider’s scale.

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* 14. What types of activities would you be interested and willing to attend this month?

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* 15. How many people would you be comfortable being active around maintaining 6ft physical distancing and 10ft physical distancing?

0 of 15 answered
 

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