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Lifestyle and Wellbeing Questionnaire

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To be completed by all participants. Parents/carers please help your children to answer these questions. The following information will help us assess what impact the Fit 4 Life Programme has had on your eating habits, physical activity levels and quality of life. We will ask you to complete the same form after 10 weeks and also after 6 months, to compare the scores.
EATING HABITS

*One adult portion of fruit or vegetables is 80g, or a handful for a child

*Fat = >3g/100g and sugar = >5g/100g

PHYSICAL ACTIVITY IN A TYPICAL WEEK

*This includes walking at work/school/home, walking to travel to a place, and any other walking that you might do for recreation, sport or leisure

*This includes walking at work/school/home, walking to travel to a place, and any other walking that you might do for recreation, sport or leisure

*This includes walking at work/school/home, walking to travel to a place, and any other walking that you might do for recreation, sport or leisure

*This includes walking at work/school/home, walking to travel to a place, and any other walking that you might do for recreation, sport or leisure

For each of the five statements please indicate which is closest to how you have been feeling over the last 2 weeks.

Data Protection

Halton Borough Council is the Data Controller for the personal information you provide. We collect and hold information about you in order to process your booking. For further information regarding data protection please visit our Data Protection and FOI web page