Rock up Netball for Workplaces

Rock up Netball for Workplaces is supported by VicHealth’s Regional Sport Program. Completing the survey below will help us to be able to provide more physical activity opportunities for people in the North East.

Are you the participant in Rock up Netball? *

No, I am a parent/guardian of the participant

Yes, I am aged 14-17 years

Yes, I am 18 years and over

What is the main location (suburb / town) where your child will participate in Rock up Netball? *

What is the main location (suburb / town) where you will participate in Rock up Netball? *

Participant First Name *

Participant Surname *

Email *

Parent Email *

Phone *

Parent Phone Number *

Participant Gender *

Male

Female

Other

Prefer not to say

Participant year of birth (YYYY) *

Postcode *

How would you prefer to be contacted? *

Mobile phone

Facebook

Are you the parent or carer of any children in your household? This includes children over 18 years. *

Yes

Your answer to these questions has no bearing to your participation in this program.

In the past week, on how many days have you done a total of 30 minutes or more of physical activity, which was enough to raise your breathing rate? *

This may include sport, exercise and brisk walking or cycling for recreation or to get to and from places, but should not include housework or physical activity that may be part of your job.

In the past week, on how many days have you done a total of 60 minutes or more of physical activity, which was enough to raise your breathing rate? *

This may include sport, exercise and brisk walking or cycling for recreation or to get to and from places.

Prior to participating in Rock up Netball, how long had it been since you participated in an organised sport program/activity outside of school? *

Prior to participating in Rock up Netball, how long had it been since your child participated in an organised sport program/activity outside of school? *

Have you played netball at a club before? *

Yes

Has your child played netball at a club before? *

Yes

Not sure

What school do you attend? (Name, Suburb/Town) *

What school does your child attend? (Name, Suburb/Town) *

Do you agree or disagree with the following statement relating to the way in which we view ourselves? There is no right or wrong answer.

Finally, these last few questions are designed solely to compare the group of people who take part in the program to the characteristics of the general population.

Where were you born? *

Australia

Overseas

Where was your child born? *

Australia

Overseas

If born overseas, how many years in total have you lived in Australia? *

If born overseas, how many years in total has your child lived in Australia? *

Do you have a disability or physical condition, which has lasted, or is likely to last for six months or more that restricts your life in some way? *

Yes

Not sure

Prefer not to say

Does your child have a disability or physical condition, which has lasted, or is likely to last for six months or more that restricts your life in some way? *

Yes

Not sure

Prefer not to say

Terms and Conditions *

I give permission for Sport North East (SNE) and its funding partners to reproduce and display photographs in which me or my child appears, in publications (including Facebook, Twitter, e-News, website), displays or paid advertising related to SNE promotion. If I do not wish for me or my child to be in any photographs or videos, I will notify SNE staff on the day prior to the beginning of the session. I consent for me or my child to take part in the activity/s by SNE, understand all information, and agree SNE will not incur any responsibility or liability for accident/injury/damage to/loss of property of me or my child during the activity. I authorise SNE to obtain medical/ambulance assistance in the case of an emergency involving me or my child, and agree to supply my child with all necessary medication and understand that staff cannot administer medication to my child. I understand that if my child misbehaves or is identified with a potential communicable disease, a nominated guardian will be required to pick my child up from the activity, or alternative arrangements will be made at my cost. Please note your non-identifiable data will be provided to La Trobe University on behalf of VicHealth. I understand and accept that it is my responsibility to advise Sport North East of changes to any information supplied and I will advise SNE if I do not wish to receive further information regarding research. I understand that I may receive further communication from SNE and that I can unsubscribe at any time.

I understand and agree to the above terms and conditions

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