Adult Sport Participation Survey January 2017 Question Title * 1. What is your age? 35 to 44 45 to 54 55 to 64 65 to 74 75 or older Question Title * 2. Do you have a long standing disability or illness? Yes No please specify (optional) Question Title * 3. Are you male or female? Male Female Question Title * 4. Do you take part in any sport or physical activity? (this includes things such as running, tennis, walking or gardening). Yes No If yes, what do you do? Question Title * 5. If yes to question 4, how many hours per week do you spend taking part? Question Title * 6. If no to question 4, what is the reason? Cost Lack of time Restricted by health Lack of knowledge where to take part Lack of opportunities in your area Other (please specify) Question Title * 7. Would you be interested in taking part in adapted activities such as Table Cricket and Touch Golf (adapted versions of the sports that can be played indoors on a table top or floor)? Yes No Question Title * 8. Where would you like to take part in sport or physical activity? Leisure Centre Gym Community Centre Other (please specify) Question Title * 9. What would you like to achieve by becoming more active? Have a healthier lifestyle Meet new people Learn new skills Other (please specify) Question Title * 10. Who would you like to participate with? Family Friends Alone Spouse/partner Sports or social club members Done