Town of Chesapeake Beach Walktober Step Challenge Registration
Walkable Community Advisory Group
Name
First Name
Last Name
Email
example@example.com
Are you a Chesapeake Beach Town resident?
Yes
No
How will you be participating? (Please check all that apply)
As an individual
With my class
As part of a self-organized group
Teacher/ School Name
Group Name
Please select the most appropriate option.
I am a Teacher
I am a Group Leader
I am not the organizer for my group
I am not participating as a group
Name of Group
Age Group
Under 18
18 - 29
30 - 44
45 - 59
60+
Prefer not to say
What is your current grade in school?
Have you participated in a step challenge before?
Yes
No
What are your step goals? (Please check all that apply)
Increase my daily steps
Reach a specific daily average
Get outside more
Improve my overall fitness
Connect with other community members
Other
Other personal goal:
What is your step goal? (Please enter the number of steps)
How will you track your steps?
Smartphone
Smartwatch/ Fitness Tracker
Pedometer
Other
Would you be interested in future Town-sponsored walking or wellness activities?
Yes!
No thank you
Maybe?
Submit
Should be Empty: