FIT FAMILIES LIFESTYLE SURVEY
DATE *
MM
/
DD
/
YYYY
TEAM NAME *
Your answer
TEAM CAPTAIN NAME *
Your answer
FIRST NAME *
Your answer
LAST NAME *
Your answer
E-MAIL *
Your answer
PHONE *
Your answer
DATE OF BIRTH *
MM
/
DD
/
YYYY
GENDER *
ROLE *
SPECIAL OLYMPICS PROGRAM NAME *
HEIGHT (FEET AND INCHES) *
Your answer
WEIGHT (POUNDS) *
Your answer
RESTING HEART RATE *
Your answer
BLOOD PRESSURE (SYSTOLIC/DIASTOLIC) *
Your answer
MODIFIED STEP TEST *
Your answer
TIMED PLANK *
Your answer
PUSH-UPS PER MINUTE *
Your answer
TIMED WALL SIT *
Your answer
STEPS PER MINUTE *
Your answer
WOULD YOU SAY THAT, IN GENERAL, YOUR HEALTH IS: *
HOW MANY SERVINGS OF FRUIT DO YOU USUALLY EAT EACH DAY? *
HOW MANY SERVINGS OF VEGETABLES DO YOU USUALLY EAT EACH DAY? *
HOW MANY GLASSES OF WATER (8 oz.) TO YOU DRINK EACH DAY? *
IN THE LAST WEEK, HOW MANY DAYS WERE YOU PHYSICALLY ACTIVE FOR AT LEAST 30 MINUTES? *
HOW MANY OF THOSE DAYS DID YOUR PHYSICAL ACTIVITY HAPPEN AT A SPECIAL OLYMPICS SPORT PRACTICE? *
Your answer
HOW MANY OF THOSE DAYS DID YOUR PHYSICAL ACTIVITY HAPPEN OUTSIDE OF A SPECIAL OLYMPICS SPORT PRACTICE? *
Your answer
DID YOU SET A GOAL TO IMPROVE YOUR SPORT PERFORMANCE (FAST TIME, STRONG PERFORMANCE) OR FITNESS (PHYSICAL ACTIVITY, NUTRITION, HYDRATION)? *
DID SETTING A GOAL HELP YOU STAY MOTIVATED?
AS YOU WORKED ON YOUR GOAL, DID YOU SEE YOUR SPORTS PERFORMANCE OR FITNESS LEVEL CHANGE?
AS YOU WORKED ON YOUR GOAL, DID YOU FEEL HEALTHIER?
DO YOU FEEL CONFIDENT MAKING HEALTHY CHOICES ABOUT YOUR PHYSICAL ACTIVITY? *
DO YOU FEEL CONFIDENT MAKING HEALTHY CHOICES ABOUT YOUR NUTRITION *
DO YOU FEEL CONFIDENT MAKING HEALTHY CHOICES ABOUT YOUR HYDRATION? *
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