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* 1. Would you be interested in participating in a six-week Senior Fitness Around Town Program?

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* 2. Please select your age range.

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* 3. Participants would be required to participate in physical activity once a week.  What day(s) of the week would be preferred?

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* 4. What time of the day would be preferred?

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* 5. What type(s) of weekly activities would you be most interested in?

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* 6. Please indicate your current level of physical activity?

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* 7. On average, how many hours a day do you engage in physical activity?

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* 8. What are some of the type(s) of physical activities that you have engaged in the last seven days?

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* 9. How often do you exercise specifically to increase muscle strength and endurance, such as using weights or pushups, etc.?

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* 10. During the past 7 days, did you engage in any of the following activities?

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* 11. The weekly activities would be primarily located within Tecumseh, such as Tecumseh Arena, Golden Age Club and Lakewood Park.  Would you require access to transportation?

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* 12. Additional comments / feedback

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