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  5. Active Living Activities
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What is your name?
   
 
 
 
Gender
 
Male
 
Female
 
 
 
Country of Origin?
   
 
 
 
What type of activities are you most interested in (Select all that apply)?
 
Hiking/Walking Group
 
Spin Class
 
Swimming
 
Zumba
 
Yoga
 
Soccer
 
Basketball

 
 
 
Are there other physical activities you are interested in? Please List below:
   
 
 
 
When can you participate?
 
Morning (9am-12pm)
 
Afternoon (12pm-5pm)
 
Night (5pm-9pm)
 
 
 
Would you be interested in cooking classes?
 
Yes
 
No
 
 
 
Do you know how to buy healthy food on a budget?
   
 
 
 
What makes it hard for you to eat healthy?
   
 
 
 
Do you use a grocery list before going shopping?