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* 1. Are you the participant or a parent/guardian? 

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* 2. Full Name:

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* 3. Date of Birth:

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* 4. Gender:

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* 5. Email or Instagram handle:

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* 6. Phone:

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* 7. Suburb or Postcode:

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* 8. How would you like to be contacted?

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* 9. In the past week, on how many days have you done a total of 60 minutes or more of physical activity, which was enough to raise your breathing rate?
This may include sport, exercise and brisk walking or cycling for recreation or to get to and from places.

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* 10. How confident are you in being able to participate in physical activity on a regular basis?

Not confident at all Extremely confident
i We adjusted the number you entered based on the slider’s scale.

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* 11. Prior to participating in the Towards Zero Unity Cup Program, how long had it been since you participated in an organised sport program/activity outside of school?

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* 12. If you have participated in organised sport outside of school in the last 12 months, how often was this?

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* 13. How did you find out about the Towards Zero Unity Cup Program?

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* 14. Do you have a disability or physical condition, which has lasted, or is likely to last for six months or more that restricts your life in some way?

T