Active Sussex Satellite Clubs Survey 2020-21

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The information below is collected by Active Sussex to monitor whether the project is succeeding in helping young people to be more physically active. The reporting of this data will be anonymised and your personal data will not be shared with any third parties. We will not contact you.

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* 1. Which sport do you participate in? If you play more than one sport in your club, please select 'Multisport'

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* 2. Which organisation is organising your club?

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* 3. First name

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* 4. Last name

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* 5. Date of birth

Date

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* 6. Gender

Male

Female

Other (please specify)

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* 7. Postcode

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* 8. Do you have any long-term illness, health problem or disability that limits your daily activities e.g. asthma, diabetes

Yes

If yes, please specify:

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* 9. What was the first date you attended this activity?
(use today’s date if this is your first session, use 1st of the month if unsure e.g. 01/05/2020)

Date

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* 10. In the past 7 days have you done any of these activities?

	More than once a week	Around once a week	Around once a fortnight	Around once a month	Less than once a month	Never
A continuous walk lasting at least 10 minutes	A continuous walk lasting at least 10 minutes More than once a week	A continuous walk lasting at least 10 minutes Around once a week	A continuous walk lasting at least 10 minutes Around once a fortnight	A continuous walk lasting at least 10 minutes Around once a month	A continuous walk lasting at least 10 minutes Less than once a month	A continuous walk lasting at least 10 minutes Never
A cycle ride	A cycle ride More than once a week	A cycle ride Around once a week	A cycle ride Around once a fortnight	A cycle ride Around once a month	A cycle ride Less than once a month	A cycle ride Never
A sport, fitness activity (such as gym or fitness classes), or dance	A sport, fitness activity (such as gym or fitness classes), or dance More than once a week	A sport, fitness activity (such as gym or fitness classes), or dance Around once a week	A sport, fitness activity (such as gym or fitness classes), or dance Around once a fortnight	A sport, fitness activity (such as gym or fitness classes), or dance Around once a month	A sport, fitness activity (such as gym or fitness classes), or dance Less than once a month	A sport, fitness activity (such as gym or fitness classes), or dance Never

Question Title

* 1. Which sport do you participate in? If you play more than one sport in your club, please select 'Multisport'

Question Title

* 2. Which organisation is organising your club?

Question Title

* 3. First name

Question Title

* 4. Last name

Question Title

* 5. Date of birth

Question Title

* 6. Gender

Question Title

* 7. Postcode

Question Title

* 8. Do you have any long-term illness, health problem or disability that limits your daily activities e.g. asthma, diabetes

Question Title

* 9. What was the first date you attended this activity? (use today’s date if this is your first session, use 1st of the month if unsure e.g. 01/05/2020)

Question Title

* 10. In the past 7 days have you done any of these activities?

* 9. What was the first date you attended this activity?
(use today’s date if this is your first session, use 1st of the month if unsure e.g. 01/05/2020)