GO Lake County Survey

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* 1. What was the date of the walk you attended?

Date / Time

Date

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* 2. Which GO Community walk/event did you attend?

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* 3. What is your Zip Code?

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* 4. What is your sex?

Male

Female

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* 5. Do you or anyone with you have any special needs or limitations?

Yes

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* 6. What is your Race?

White or Caucasian

Black or African American

Hispanic or Latino

Asian or Asian American

American Indian or Alaska Native

Native Hawaiian or other Pacific Islander

Another race

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* 7. How many times in a week do you participate in physical activity? (select one)

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* 8. Has having GO walking events increased opportunities for you to be physically active?

Yes

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* 9. How important is having a walking program in your community?

Very important

Somewhat important

Not at all important

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* 10. Did you participate in today's GO event with family or friends?

Yes

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* 11. If Yes, how many?

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* 12. What is your age and ages of all your participants?

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* 13. Where do you engage in physical activity (Please check all that apply)

Health club/gym

At home

My park district

Forest Preserves

My neighborhood

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* 14. Are you walking to manage a medical or health condition?

Yes