{"id":36444,"date":"2021-05-10T15:27:45","date_gmt":"2021-05-10T14:27:45","guid":{"rendered":"https:\/\/visionrcl.org.uk\/?page_id=36444"},"modified":"2025-06-04T08:44:45","modified_gmt":"2025-06-04T07:44:45","slug":"active-stars-3-month-follow-up-questionnaire","status":"publish","type":"page","link":"https:\/\/isca00.bigwaveserver.co.uk\/~visionrc\/sport-health-physical-fitness\/health-and-wellbeing\/weight-management\/activestars\/active-stars-3-month-follow-up-questionnaire\/","title":{"rendered":"Active Stars: 3 Month Follow-Up Questionnaire"},"content":{"rendered":"\n<p>The following form is to be filled in three months after completing the <strong>Active Stars programme<\/strong>.<\/p>\n\n\n\n<p>This form should take no longer than 15 minutes to complete. Please answer questions as honestly as possible. <\/p>\n\n\n\n<div style=\"height:32px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f36443-o1\" lang=\"en-GB\" dir=\"ltr\" data-wpcf7-id=\"36443\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/~visionrc\/wp-json\/wp\/v2\/pages\/36444#wpcf7-f36443-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contact form\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"36443\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.2\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_GB\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f36443-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/fieldset>\n<h4>Your details\n<\/h4>\n<p>All fields required\n<\/p>\n<p><label>Parent\/Carer's Full Name (required)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-name\" \/><\/span> <\/label>\n<\/p>\n<p><label>Child's Full Name (required)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"child-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"child-name\" \/><\/span> <\/label>\n<\/p>\n<p><label>Child's Age (required)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"child-age\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"child-age\" \/><\/span> <\/label>\n<\/p>\n<p><label>Child's Date of Birth (required)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Date-Of-Birth\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-required wpcf7-validates-as-date\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"Date-Of-Birth\" \/><\/span><\/label>\n<\/p>\n<p><label>Child's Gender (required)<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"radio-gender\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"radio-gender\" value=\"Male\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Male<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"radio-gender\" value=\"Female\" \/><span class=\"wpcf7-list-item-label\">Female<\/span><\/span><\/span><\/span>\n<\/p>\n<p><label>Date of course attended (required)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"date-course\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-required wpcf7-validates-as-date\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"date-course\" \/><\/span><\/label>\n<\/p>\n<p><label>Location of course attended (required)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"location-course\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"location-course\" \/><\/span> <\/label>\n<\/p>\n<p><label>Email Address (required)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"your-email\" \/><\/span> <\/label>\n<\/p>\n<h4>Questionnaire\n<\/h4>\n<p><label>Have you managed to maintain healthy eating habits \/ have healthy eating habits developed any further at home as a result of attending Active Stars?<br \/>\n(e.g. an increase in consumption of fruit and veg \/ a decrease in consumption of sugar \/ fatty foods).<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"textarea-maintain-habits\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"textarea-maintain-habits\"><\/textarea><\/span><\/label>\n<\/p>\n<p><label>How often does your child take part in structured physical activity e.g. sport lessons, clubs, swimming?<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"radio-activity\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"radio-activity\" value=\"daily\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">daily<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"radio\" name=\"radio-activity\" value=\"2-3 times weekly\" \/><span class=\"wpcf7-list-item-label\">2-3 times weekly<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"radio\" name=\"radio-activity\" value=\"once a week\" \/><span class=\"wpcf7-list-item-label\">once a week<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"radio\" name=\"radio-activity\" value=\"every two weeks\" \/><span class=\"wpcf7-list-item-label\">every two weeks<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"radio\" name=\"radio-activity\" value=\"once a month\" \/><span class=\"wpcf7-list-item-label\">once a month<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"radio\" name=\"radio-activity\" value=\"less than once a month\" \/><span class=\"wpcf7-list-item-label\">less than once a month<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"radio-activity\" value=\"never\" \/><span class=\"wpcf7-list-item-label\">never<\/span><\/span><\/span><\/span>\n<\/p>\n<p><label>How often is your child active through outdoor play and recreational activities at home?<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"radio-play\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"radio-play\" value=\"daily\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">daily<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"radio\" name=\"radio-play\" value=\"2-3 times weekly\" \/><span class=\"wpcf7-list-item-label\">2-3 times weekly<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"radio\" name=\"radio-play\" value=\"once a week\" \/><span class=\"wpcf7-list-item-label\">once a week<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"radio\" name=\"radio-play\" value=\"every two weeks\" \/><span class=\"wpcf7-list-item-label\">every two weeks<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"radio\" name=\"radio-play\" value=\"once a month\" \/><span class=\"wpcf7-list-item-label\">once a month<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"radio\" name=\"radio-play\" value=\"less than once a month\" \/><span class=\"wpcf7-list-item-label\">less than once a month<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"radio-play\" value=\"never\" \/><span class=\"wpcf7-list-item-label\">never<\/span><\/span><\/span><\/span>\n<\/p>\n<p><label>On a typical day, how often does your child play computer games and\/or watches television (including watching films etc) for?<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"radio-screen-activity\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"radio-screen-activity\" value=\"30 minutes\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">30 minutes<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"radio\" name=\"radio-screen-activity\" value=\"1 hour\" \/><span class=\"wpcf7-list-item-label\">1 hour<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"radio\" name=\"radio-screen-activity\" value=\"2 hours\" \/><span class=\"wpcf7-list-item-label\">2 hours<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"radio\" name=\"radio-screen-activity\" value=\"4 hours\" \/><span class=\"wpcf7-list-item-label\">4 hours<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"radio-screen-activity\" value=\"6 hours\" \/><span class=\"wpcf7-list-item-label\">6 hours<\/span><\/span><\/span><\/span>\n<\/p>\n<p><label>Have you and your family used any resources such as the Change 4 Life Sugar app, Vision app, DoMore guide etc, to support the changes you have made?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"textarea-resources\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"textarea-resources\"><\/textarea><\/span><\/label>\n<\/p>\n<p><label>Do you feel that you and your family need supporting information to enable you to make more healthy changes?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"textarea-support\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"textarea-support\"><\/textarea><\/span><\/label>\n<\/p>\n<p><label>Are you still concerned about your child\u2019s weight?<br \/>\n(If they require further support they can contact their GP to discuss being referred to a more specialist service e.g. Dietetics)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"textarea-concern\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"textarea-concern\"><\/textarea><\/span><\/label>\n<\/p>\n<p><label>Would you recommend the Active Stars programme to friends\/relatives? Why \/ why not?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"textarea-recommend\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"textarea-recommend\"><\/textarea><\/span><\/label>\n<\/p>\n<p><label>Do you have any comments about the Active Stars programme, such as suggestions for improvement \/ things to include in future programmes?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"textarea-improve\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"textarea-improve\"><\/textarea><\/span><\/label>\n<\/p>\n<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Send\" \/>\n<\/p><input type='hidden' class='wpcf7-pum' value='{\"closepopup\":false,\"closedelay\":0,\"openpopup\":false,\"openpopup_id\":0}' \/><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n\n","protected":false},"excerpt":{"rendered":"<p>The following form is to be filled in three months after completing the Active Stars programme. This form should take no longer than 15 minutes to complete. Please answer questions as honestly as possible.<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":8269,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"page-general-article.php","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-36444","page","type-page","status-publish","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/isca00.bigwaveserver.co.uk\/~visionrc\/wp-json\/wp\/v2\/pages\/36444","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/isca00.bigwaveserver.co.uk\/~visionrc\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/isca00.bigwaveserver.co.uk\/~visionrc\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/isca00.bigwaveserver.co.uk\/~visionrc\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/isca00.bigwaveserver.co.uk\/~visionrc\/wp-json\/wp\/v2\/comments?post=36444"}],"version-history":[{"count":3,"href":"https:\/\/isca00.bigwaveserver.co.uk\/~visionrc\/wp-json\/wp\/v2\/pages\/36444\/revisions"}],"predecessor-version":[{"id":110929,"href":"https:\/\/isca00.bigwaveserver.co.uk\/~visionrc\/wp-json\/wp\/v2\/pages\/36444\/revisions\/110929"}],"up":[{"embeddable":true,"href":"https:\/\/isca00.bigwaveserver.co.uk\/~visionrc\/wp-json\/wp\/v2\/pages\/8269"}],"wp:attachment":[{"href":"https:\/\/isca00.bigwaveserver.co.uk\/~visionrc\/wp-json\/wp\/v2\/media?parent=36444"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}