It’s Your 150! High School Challenge Consent Form

Would you be interested in being a Team Leader for your school?

Yes
No

In an average week, how often do you engage in the following activities for 10 minutes or longer?

Walking

1-2 times
3-4 times
5-6 times
7+ times
Never

Running

1-2 times
3-4 times
5-6 times
7+ times
Never

Biking

1-2 times
3-4 times
5-6 times
7+ times
Never

Push Wheel Chair

1-2 times
3-4 times
5-6 times
7+ times
Never

Skateboarding

1-2 times
3-4 times
5-6 times
7+ times
Never

How do you usually get to school?

Get dropped off in a car
Take the bus
Walk or run
Bike
Other

Consent

My parent(s)/legal guardian(s) is aware of this challenge and have provided me consent to participate.

Personal information is being collected in this program, under the authority of the Municipal Act for the purpose of gathering feedback to help support the development of the town’s active transportation routes. Your information will not be distributed to any external sources and will only be used by the study team. If you have any questions about this collection or how personal information will be used by the town, please contact Chris Clapham, Sustainable Transportation Program Coordinator, by phone at 905‑845‑6601 ext. 3306, or by email at chris.clapham@oakville.ca