2017 Communities ChooseWell Registration Form
Communities ChooseWell requires that all participants register, or re-register, for the program by completing this registration questionnaire. It is mandatory that you complete the first section: "Contact and Community Information".

The other questions are voluntary. We do, however, strongly encourage you to complete them. Your responses will help us to better understand the communities that are participating in the Communities ChooseWell program and to demonstrate to our funder (Alberta Health) any difference that the program is making. Most importantly, we will use these finding to continue to strengthen the relevance and effectiveness of the Communities ChooseWell Program.

Questionnaire data will be kept confidential and secure. Only our Communities ChooseWell program evaluation team will see the data, and we will report only on aggregate information. If we use any illustrative examples or quotes from the registration questionnaire (such as to share an example of community success), we will take care not to include any identifiable information, unless you give us permission to do so. We may share the aggregate information with ChooseWell champions, the Communities ChooseWell Advisory Committee, our funder, and in various conference presentations and reports.

If you have any questions or concerns about this survey, please contact Chantel Churcher at 780-643-1252 or cchurcher@arpaonline.ca. To proceed to the registration form, please check the box below:

Do you consent to complete this registration form?
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