Lifestyle Questionnaire

Fill in this form as soon as you start with ETW to help us get an idea of your lifestyle, goals and motivations. Feel free to resubmit the form at any time to give us an update on your lifestyle

Contact Details

Please fill in your contact details.

Firstname:*
Surname:*
Phone - Mobile:*
Email:*

Q 1: Which KLIK (group) do you belong to?

Please select -------------------- Balmain - SYD - Julia Challenor Balmoral - SYD - Rod Cotty Bondi - SYD - Aaron Laurence Bronte - SYD - Matt Buckland Cammeray - SYD Coogee - SYD - Jayne McPherson Maroubra - SYD - Maciek Queens Park - SYD - Samantha Hannaford Rozelle - SYD - Cameron Gerrie Rushcutters - SYD - Rob Meneses Paddington - BRIS - Amy Bridle

Lifestyle

Q 2: What 2 goals can you set for yourself from participating in Evolution Outdoors? (If your attending the trial then consider the trial and your ongoing commitment to fitness training)

Q 3: How will you determine whether or not you have reached these goals? (i.e. how will you know?)

Q 4: What are 2 challenges or obstacles that you may face that could get in the way of you achieving the above goals?

Q 5: What do you need to commit to for the next 8 weeks to overcome the above obstacles and reach your goals?

Q 6: Which days each week are you hoping to attend?

Q 7: How would you rate your stress levels on a scale of 1-10? (10 being highly stressed)

Please select -------------------- 1 - Never stressed 2 3 4 5 6 7 8 9 10 - Highly stressed

Q 8: How would you rate your energy levels on a scale of 1-10?

Please select -------------------- 1 - Extremely low 2 3 4 5 6 7 8 9 10 - Extremely high

Q 9: Do you smoke?

Please select -------------------- Yes No

Q 10: If yes, how many per day?

Please select -------------------- 1-5 6-10 11-15 16-20 20+

Q 11: How many hours sleep do you get per night, on average?

Q 12: Is it quality sleep?

Please select -------------------- Yes No

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