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Walk Across Texas!

Family Development and Resource Management, Family and Consumer Sciences, Texas AgriLife Extension Service, The Texas A&M University System

Team Captain Registration

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Team Captain's First Name:

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Choose your County:

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Enter Your City:
(i.e. Houston)

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Enter Your 5-Digit Zip Code:

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Enter Your Team Name:

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Capitain's Password:

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My team is made up of people from my:

4-H Club

School

If Your Organization Is Not Listed Above, Enter Here

Church

TEEA

Family

Worksite

Neighborhood

Other

Community Organization

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Team Captain's Gender:
Female Male

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Team Captain's Age:
years

Team Captain's Ethnic Background:

Anglo	African-American	Asian
Hispanic	Native American	Other (specify)

Signed Registration Form Submitted to Team Captain:
Yes No

  Currently, are you physically active at least 30 minutes 5 days a week?
     Yes            No
  How many minutes a day are you physically active at this time?

If you are physically active, which of these fitness activities do you do now? (Check all that apply.)

A. I do no fitness activity now.	D. Swim
B. Walk	E. Ride bicycle
C. Run	F. Other (specify)

Where do you do these fitness activities? (Check all that apply.)

A. Parks	D. Local mall	G. Other (specify)
B. Local gym/fitness center	E. School track
C. Home fitness center	F. Neighborhood

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