Virtual AMA Youth Run Club Finisher Prize Form

Thank you for participating in the Virtual Alberta Medical Association Youth Run Club. We hope you had fun and enjoyed participating! Please fill out the questions below to be automatically entered to win 1 of many Garmin activity trackers. If you are a parent and filling this form out with your children, please fill it out as a family and we will enter each name separately for the draw.

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* 1. Please enter the full name(s) that you would like on the Certificate of Participation

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* 2. Please enter the school name of all participants

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* 3. Please check off the grade range of all participants:

K-3

4-6

7-9

10-12

Adult

Other (please specify)

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* 4. Please answer the following questions about your experience with the Virtual AMA Youth Run Club

	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree
Physical activity (running or walking) makes me feel happy and healthy	Physical activity (running or walking) makes me feel happy and healthy Strongly Agree	Physical activity (running or walking) makes me feel happy and healthy Agree	Physical activity (running or walking) makes me feel happy and healthy Neutral	Physical activity (running or walking) makes me feel happy and healthy Disagree	Physical activity (running or walking) makes me feel happy and healthy Strongly Disagree
I want to continue running or participating in physical activity	I want to continue running or participating in physical activity Strongly Agree	I want to continue running or participating in physical activity Agree	I want to continue running or participating in physical activity Neutral	I want to continue running or participating in physical activity Disagree	I want to continue running or participating in physical activity Strongly Disagree
I feel supported to make healthy choices	I feel supported to make healthy choices Strongly Agree	I feel supported to make healthy choices Agree	I feel supported to make healthy choices Neutral	I feel supported to make healthy choices Disagree	I feel supported to make healthy choices Strongly Disagree
I enjoyed being apart of the Virtual AMA Youth Run Club	I enjoyed being apart of the Virtual AMA Youth Run Club Strongly Agree	I enjoyed being apart of the Virtual AMA Youth Run Club Agree	I enjoyed being apart of the Virtual AMA Youth Run Club Neutral	I enjoyed being apart of the Virtual AMA Youth Run Club Disagree	I enjoyed being apart of the Virtual AMA Youth Run Club Strongly Disagree

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* 5. If the AMA Youth Run Club were to continue to offer an at-home run club program would you participate?

Yes

Other (please specify)

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* 6. Are there any final comments or thoughts you would like to leave?

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* 7. Please enter the contact information where we can mail the certificates and finisher prizes to.

Name

Address

Address 2

City/Town

Province

Postal Code

Email Address