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In the past 4 weeks on how many days have you done 60 minutes sport and recreational physical activity outside of work or education when the effort was usually enough to raise your breathing rate? Include activities such as brisk walking or cycling:

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Please tell us which of the following sports interest you:

Athletics

Badminton

Cricket

Cycling

Dance

Football

Golf

Gymnastics

Hockey

Netball

Rowing

Rugby

Swimming

Tennis

Triathlon

Walking

Your information is strictly confidential. We will find this personal data useful for monitoring the success of our programmes, to help us with planning future sports and activities and we would like to be able to send you details of any further sports opportunities that may be of interest. You may also be invited to take part in a survey conducted by consultants working on behalf of Sport England. We will collect and process all personal data in line with the Data Protection Act 1998. Please tick this box if you are happy for this to happen.

Are you happy for us to share your data with our partners (Local Authorities, National Governing Bodies of Sport, Norfolk School Sport Partnerships).

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