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Please note we need the Phone, Street Address, and Town fields, so please add them as they are required for SWITCH reporting purposes.

First Name

Last Name

Email address

Phone Number

Street Address

Town

Post Code

Gender

Birth Date

Are you the parent or carer of any children in your household? Yes No
This includes children over 18 years.

Where were you born? Australia Overseas

If born overseas, how many years in total have you 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 No Not Sure Prefer not to say

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.

How confident are you about being able to participate in physical activity on a regular basis? (required)

1 2 3 4 5 6 7 8 9 10
1 being not confident at all and 10 being extremely confident.

Published by

Peter Shaw

Peter Shaw has been involved in touch since 2001 when he returned from playing semi professional rugby in England. He is the president and founder of Princes Park Touch Association View all posts by Peter Shaw