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Lifestyle Survey - Fitness & Wellness Programs
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1.
Your first and last name:
(Required.)
2.
Your email:
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3.
I participate as a(n):
(Required.)
Athlete
Caregiver
Coach
Community Member
Parent
Unified Partner
Other (please specify)
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4.
I describe myself as:
(Required.)
American Indian/Alaskan Native
Asian American
Black or African American
Hispanic or Latinx
Native Hawaiian/Pacific Islander
White/Caucasian
Prefer not to answer
Other (please specify)
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5.
Your team or school name:
(Required.)
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6.
Which Special Olympics area do you belong to?
(Required.)
Basin (Adams/Grant Counties)
Capitol Area (Pierce/Thurston/Lewis/Grays Harbor/ Pacific Counties)
Cascade Area (Snohomish/Whatcom/Skagit/Island Counties)
Columbia River Area (Clark/Cowlitz/Skamania/Wahkiakum Counties)
King County Area (King County)
North Central Area (Douglas/Okanogan/Chelan Counties)
Northeast Area (Spokane/Ferry/Stevens/Lincoln/Pend Oreille Counties)
Peninsula Area (Clallam/Jefferson/Kitsap/Gig Harbor/Mason Counties)
Southeast Area (Whitman/Asotin/Columbia/Garfield Counties)
Tri-Cities Area (Benton/Franklin Counties)
Valley Area (Yakima/Ellensburg/Sunnyside/Kittitas/Klickitat Counties)
Walla Walla Area (Walla Walla County)
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7.
What Healthy Communities Program are you participating in?
(Required.)
CommUNITY Challenge
Fit 5
Fitness Heptathlon
School of Strength
SOfit
SONA Move Challenge
Unified Fitness Club
Walking Club
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8.
What is your t-shirt size?
(Required.)
XS
Small
Medium
Large
XL
2XL
3XL
4XL
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9.
After participating in this program, I can make healthier choices about nutrition:
(Required.)
True
False
Unsure
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10.
After participating in this program, I can make healthier choices about hydration:
(Required.)
True
False
Unsure
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11.
After participating in this program, I can make healthier choices about exercise:
(Required.)
True
False
Unsure
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12.
After participating in this program, I feel better about my mental health:
(Required.)
True
False
Unsure
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13.
This program helped me achieve my health goal:
(Required.)
True
False
Unsure
14.
What health goal did you accomplish?
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15.
What was your favorite part about participating in this program?
(Required.)
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16.
Did you notice any positive changes in your health after participating in this program? Please share!
(Required.)
17.
Do you have any suggestions to help us improve this program?
18.
Upload photos from your program:
Choose File
No file chosen
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