Active at Home Programme

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The Melton & Belvoir and South Charnwood School Sport & Physical Activity Networks hope you are looking forward to taking part in the Active at Home programme.

Please take a few minutes to give us some information about yourself. This information will be used gauge the overall impact of this programme across all schools, not as a way to monitor individuals.

We will also ask you some of the same questions at the end of week 10.

Taking part in both questionnaires will enter you into a prize draw for a £50 amazon gift card so make sure you use the same initials when filling in the forms.

Thanks,
Melton & Belvoir and South Charnwood SSPANs.

Initials (e.g. John Smith - JS) *

School *

What year are you in at school? *

What best describes your gender? *

Which one of the following best describes your ethnic group or background? *

White

Mixed/Multiple ethnic groups

Asian/Asian British

Black/African/Caribbean/Black British

Other ethnic group

Prefer not to say

Select all that apply to you below: *

I have a physical disability

I have a learning disability

Prefer not to say

No disability

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