You are about to take part in an Active Southend funded activity session. As a result we would appreciate if you can complete the below survey. The survey will take approximately 5 minutes. Thank you in advance.

About You

Below are some statements about feelings and thoughts.

7. Please tick the box that best describes your experience of each over the last 2 weeks

1 = not confident at all, 10 = very confident
1 = not confident at all, 10 = very confident
Please do not include PE if you are a student
*Activity where you raise your heart rate and feel a little out of breath. **Activity where you are breathing hard and fast and your heart rate has increased significantly.

Please tick to confirm you have read and agree with the Terms and Conditions and Privacy Policy.
Active Essex will use the data you present in this form for use of Active Southend evaluation data, in compliance with GDPR.

Thank you for taking the time to complete this survey.