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2. Age Range*

   1. 18 and under
   2. 18-29

   1. 30-39

   1. 40-49

   1. 50 and over
4. Gender*
6. Height
7. Weight
9. How often do you perform physical activity causing your heart rate to rise, breathing rate to increase, and/or cause you to sweat in an average week?*

   1. Less than 60 mins/week
   2. 60-120 min/week

   1. 120-180 min/week

   1. 180-240 min/week

   1. Over 240 min/week
11. Please indicate reasons why you’re not more physically active:

    1. Not enough time
    2. Not motivated
    3. Too tired
    4. Cost of gym membership/drop in fitness classes
    5. Health issues
    6. Other
12. If other, please explain:
14. What programming would help you achieve a healthier lifestyle?

    1. More affordable drop-in fitness classes
    2. More drop-in sport options/times
    3. More fitness challenges – such as pedometer walking challenge, tracking how far individuals walk over the course of a month
    4. Informational wellness workshops, and brochures
    5. Affordable personal trainers to design individualized workout programs to do on your own time
    6. More low-impact options, like stretching and walking classes
    7. Other
15. If other, please explain
17. What other health and well-being initiatives would you like to see available in this community?
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