Baw Baw Empowering Pies Program

Privacy

Privacy statement: The following personal information you provide in this survey, will only be used for giving feedback and reporting to Council. You can access your own personal information by contacting Council’s Privacy and Freedom Information Officer on 5624 2411

Question Title

* 1. Please complete the details below.

Full Name

Age

Postal Code

Email Address

Contact Number

Question Title

* 2. Date of Birth

Date

Question Title

* 3. Parent/Guardian Contact Details

Full Name

Contact Number

Question Title

* 4. Please tell us about your experience with sport and/or physical activity.

I am currently involved in non-sport based physical activities

I am a current member of a sports club

I am not currently physically active

Other (please specify)

Question Title

* 5. Are you a member of a sporting club? If so, please comment which sporting club.

Question Title

* 6. Is there something in particular you’d like to get out of Empower Pies program?

Question Title

* 7. Would you like to receive information of future youth events or activities?

Yes