Active Sussex Children and Young People Investment Fund survey ages 12-19

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This information is collected by Active Sussex to find out what helps young people to be more physically active. Only your activity provider and Active Sussex see this information. You, or your parents, can decide that you do not want to do this survey - just tell your coach or teacher. We will not contact you. You can view the Active Sussex privacy policy at: www.activesussex.org/privacy-policy

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* 1. First name

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* 2. Last name

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* 3. Year of birth

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* 4. Which gender do you identify as?

Male

Female

In another way (please specify)

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* 5. Your home postcode (if you know it)

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* 6. Which one of these best describes your background or race?

White (British or English)

White (not British or English)

Mixed race

Asian or British Asian

Black or Black British

Prefer not to say

Other (please specify)

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* 7. Do you need extra help with any of these things?

Moving around including walking and running

Using your hands for writing or to pick things up

Seeing and using your eyes

Hearing and using your ears

Speaking

Breathing

Reading or writing

Using numbers

How you feel

How you behave

I don't need extra help with any of these things

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* 8. How often do you do any of the activities below?

	More than once a week	Around once a week	Around once a fortnight	Around once a month	Less than once a month	Never
Walking, cycling, scooting or running to get somewhere	Walking, cycling, scooting or running to get somewhere More than once a week	Walking, cycling, scooting or running to get somewhere Around once a week	Walking, cycling, scooting or running to get somewhere Around once a fortnight	Walking, cycling, scooting or running to get somewhere Around once a month	Walking, cycling, scooting or running to get somewhere Less than once a month	Walking, cycling, scooting or running to get somewhere Never
Playing sport, doing a fitness activity, swimming or dance	Playing sport, doing a fitness activity, swimming or dance More than once a week	Playing sport, doing a fitness activity, swimming or dance Around once a week	Playing sport, doing a fitness activity, swimming or dance Around once a fortnight	Playing sport, doing a fitness activity, swimming or dance Around once a month	Playing sport, doing a fitness activity, swimming or dance Less than once a month	Playing sport, doing a fitness activity, swimming or dance Never
Running or cycling around for fun, trampolining, skating or climbing	Running or cycling around for fun, trampolining, skating or climbing More than once a week	Running or cycling around for fun, trampolining, skating or climbing Around once a week	Running or cycling around for fun, trampolining, skating or climbing Around once a fortnight	Running or cycling around for fun, trampolining, skating or climbing Around once a month	Running or cycling around for fun, trampolining, skating or climbing Less than once a month	Running or cycling around for fun, trampolining, skating or climbing Never
PE or any other physical activity in school	PE or any other physical activity in school More than once a week	PE or any other physical activity in school Around once a week	PE or any other physical activity in school Around once a fortnight	PE or any other physical activity in school Around once a month	PE or any other physical activity in school Less than once a month	PE or any other physical activity in school Never