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Account Registration
* - required fields
Lorain County Walks
Registration
*
First Name:
*
Last Name:
*
Birthdate:
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Address:
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City, State Zip:
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*
Telephone Number:
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E-mail Address:
*
Desired Username:
*
Password:
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Verify Password:
*
What school district do you live in?
Select One
Amherst Schools
Avon Lake City Schools
Avon Local Schools
Clearview Local Schools
Columbia Local Schools
Elyria City Schools
Firelands Local Schools
Keystone Local Schools,
Lorain City Schools
Midview Local Schools
North Ridgeville Schools
Oberlin City Schools
Sheffield-Sheffield Lake
Vermilion Schools
Wellington Schools
Other
*
Do you have children in that school district?
Yes
No
*
Gender
Male
Female
*
Ethnic Background:
Am. Indian
Hispanic
Asian Pacific
White
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Other
*
How did you hear about
Lorain County Walks
?
Newspaper
Lorain County Fair
Radio
Work
Church
Friend
Doctor
School
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Other
*
On a scale of 1 to 10, where 10 is "highly motivated" and 1 is "not at all motivated", how motivated are you now to increase your physical activity?
10
9
8
7
6
5
4
3
2
1
*
Do you use a pedometer?:
Yes
No
*
Please check up to three of the reasons you decided to participate:
I want to improve my physical health.
I want to improve my mental health and/or feel better about myself.
I want to improve my appearance.
I want to be part of and to support my team.
It will motivate me to increase my current level of physical activity.
Family, friends, or co-workers encouraged me to participate.
Other
Height:
ft.
inches
Weight:
.lbs
Blood Pressure:
/
mmHg
Cholesterol:
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