#QTYflex - Winter/Spring 2019
An Alternative Queer and Trans Youth (12-18 years) Fitness Program
Email address *
Name (chosen, preferred or given) *
Your answer
Pronouns (Pronouns can be tough... it's ok if you don't know or if they change!) *
Your answer
Birthday *
MM
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DD
/
YYYY
Phone number *
Your answer
Emergency Contact (Name & phone number) *
Your answer
How did you hear about this program? *
Your answer
What is your experience with sports, working out or fitness of any kind? *
Your answer
If you have fitness goals, what are they? *
Your answer
What, if anything, gets in the way of you achieving these goals or getting into sports or fitness of any kind (Some folks have said things like: fear of judgment, not knowing what to do at the gym, gendered change rooms, cost, and more...there are no wrong answers)? *
Your answer
What is your favourite meme? *
Your answer
Do you have injuries that may prevent you from doing certain exercises or any accessibility needs? If yes, please tell us more so we can work together safely! *
Your answer
Do you have any allergies or scent sensitivities?If yes, please tell us more so we can work together safely! *
Your answer
Have you had surgery in the last year? If yes, please tell us more so we can work together safely! *
Your answer
Please list all medications, hormones or supplements you might be taking *
Your answer
Do you wear a chest binder? *
If yes, do you require one for fitness? *
If yes, what size do you wear? (enter n/a if you do not require a chest binder for fitness) *
Your answer
Do you like cats or dogs better? *
What communities are you apart of (this could any community: school, 2SLGBTQ+, your Edmonton community, etc... again, no wrong answers!)? *
Your answer
How do you feel about the communities you are apart of? *
Your answer
This program runs for 10 consecutive Thursdays from 4:30-6pm starting February 14th, 2019. Do you think you can make most of these? *
On a scale of 1-10 (1 being a wet dish cloth; 10 being a candy buffet), how excited are you about this program? *
Your answer
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