Walk It Out Wednesday Registration Form and Pre-Challenge Survey

  • Walk It Out Wednesday Challenge

    Walker Registration Form

  • What’s the Walk It Out Wednesday Challenge?

    The purpose of the Walk It Out Wednesday (WOW) Challenge is to urge everyone to move more. Unfortunately, many people in DeKalb County do not get enough physical activity. This challenge will encourage you to walk every Wednesday and to make walking a habit.

    Walking is a very easy way to stay active. It’s free and simple. You don’t need a gym membership or special equipment. Plus, you can walk almost anywhere — in your neighborhood, in a park, or at work, school, or your house of worship!

    The WOW Challenge is sponsored by DeKalb Public Health’s Local Efforts towards Addressing Disparities in DeKalb (LEAD DeKalb). The Centers for Disease Control and Prevention’s Racial and Ethnic Approaches to Community Health (REACH) initiative funds LEAD DeKalb.

     

    What are the benefits of walking?

    Regular walks can help you:

    • Improve your heart health.
    • Lower your stress level.
    • Boost your mood.
    • Manage your weight.
    • Improve your sleep.
    • Reduce your risk of chronic diseases.
    • Strengthen your bonds with family members, friends, and neighbors when you walk together.

     

    How does the challenge work?

    The challenge runs for 12 Wednesdays from May 27 through August 12. Join at any time! You can walk at any pace and for any distance. You can walk any place — indoors or outdoors — wherever you feel safe and comfortable.

    Every Wednesday, you’ll track your steps using a smartphone, fitness tracker, or pedometer.* Then, you’ll simply submit the number of steps you walked that day using an online form on the challenge’s website. Walkers will receive giveaways and prizes!

     

    Who can participate?

    Anyone who lives, works, attends school, or worships in DeKalb County can join the challenge.

    Remember: Any pace. Any place. Just walk! 

    *Or you can estimate your steps. One mile (or 20 minutes) = 2,000 - 2,500 steps.

  • Participation Agreement

  • For Adults Ages 18 and Older

    Please indicate whether you agree with the following statements:

    • I understand this is a voluntary physical activity program.
    • I will participate at my own pace and ability.
  • *

  • Section 1: Who You Are

  • Format: (000) 000-0000.

  • Section 2: Where You Live

  • Section 3: About You

  • What is your gender?*
  • With which racial group(s) do you identify? (Select all that apply.)*
  • What is your ethnicity?*

  • Section 4: Your Participation

  • How will you track your steps?*
  • Where do you plan to walk most often? (Check one.)*

  • Section 5: Staying Connected

  • How did you hear about the WOW Challenge?*
  • Would you like to complete the optional pre-challenge survey now?*

  • Walk It Out Challenge
    Pre-Challenge Survey

    Welcome,

    As part of registering, please complete this pre-challenge survey. Please complete the survey only if you live, work, play, and/or worship in DeKalb County, Georgia.

    The Walk It Out Wednesday Challenge is a countywide physical activity initiative to help individuals begin or continue efforts to become more physically active. The challenge encourages participants to walk on Wednesday from May 27 through August 12 as part of a simple, consistent routine.

    Thank you for taking the time to complete this survey. Please respond to all the items.

    Your feedback is valuable. It will help us strengthen the Walk It Out Wednesday Challenge and plan future initiatives that reflect the needs, interests, and experiences of the DeKalb County community. All participants who complete this survey will receive a monetary incentive for your time and participation.

  • In the space provided, enter the first letter of your first name, the first letter of your last name, and your month and day of birth in 4 digits. Example: Alex Smith, born on May 03, would be AS0503. This is for data purposes only.

  • Do you live, work, play, or worship in DeKalb County, Georgia?*

  • Part I.

    The following questions ask about your background.
  • What is your employment status? (Check all that apply.)*
  • Do you have health insurance?*
  • Do you have any of the following diagnosed health conditions? (Check all that apply.)

  • Part II.

    The following statements ask about your awareness, perceptions, and motivation related to walking and physical activity.

  • Please indicate how much you agree or disagree with each statement using the scale below:

  • Rows

  • Part III.

    The next questions allow you to share your experience with being physically active.

  • Participation Agreement

  • For Minors Ages 6 through 17 (required): Parent/Guardian Consent

    I, the undersigned parent or legal guardian of the participant named above, hereby give my full consent for my child to participate in DeKalb Public Health’s Walk It Out Wednesday Challenge. I acknowledge that I have reviewed the information provided and understand the nature of the activities involved.

  • Format: (000) 000-0000.
  • Parent/Guardian Consent Date*
     - -

  • Thank you again for completing this survey. Your feedback is greatly appreciated.


    Be sure to follow us at @LEADDeKalb!

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