Full Name:      Age:

Gender:

School/College/place of work (if applicable):

Ethnicity:      Religion:

Town:

Email:

1. What sport(s) do you currently participate in?
   

2. What do you like most about the sport(s) you currently play? (please tick relevant boxes)

 Taking part in competitions and matches      Playing casual games      Keeping fit

 Spending time with friends      Different sports on offer at sessions

Other? (Please state)
   

3. If you don't currently participate in any sports activities or have recently stopped taking part, why is this? (e.g. no time, don't like sport, too expensive, travel is an issue, not sure what's available locally, what i would like to do is not available)?
   

4. Would you be less or more likely to attend an activity session if the coach/instructor included included fitness and nutritional advice?

 More Likely       Unsure       Less likely

5. Who do you / would you like to attend sports sessions with and why?

Family (e.g. parents/carers/siblings

Friends

By myself

Other? (please state)
   

Why?
   

6. What preferred day and time would you like to take part in sport activities? (e.g. Wednesdays, 5pm onwards, weekends at anytime, after school etc..)
   

7. What sports or activities would you like to take part in or do more of? (this can include traditional sports, alternative sports/activities or fitness-based activities anything you fancy, in fact!)
   

8. Do you have any children? If so does this pose a barrier to you partaking in sport or activity?
How many children do you have?    How old are your children?   

Would you be interested in a free childcare service, to enable you to join in a sports/activities session?

 Yes      No

Which of the following would you like to try (if any)?

 Free Running      Cheerleading

 Gymnastics      Dance

 Indoor Football      Indoor Cricket