Game On! Week 5 Participation

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* 1. Full Name

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* 2. Rate your success in completing this week's small steps.

	Very high	High	Moderate	Low	Very low
Nutrition	Nutrition Very high	Nutrition High	Nutrition Moderate	Nutrition Low	Nutrition Very low
Physical Activity	Physical Activity Very high	Physical Activity High	Physical Activity Moderate	Physical Activity Low	Physical Activity Very low

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* 3. Did you use the tracker or a mobile app to record/journal your progress?

Yes, the tracker

Yes, a mobile app

No

If you answered "Yes, a mobile app," please specify the app's name

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* 4. Share a tip that helped you complete the challenge. (Optional)

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* 5. Can we share your tip in the Game On newsletter or webpage?

Yes and you may include my name

Yes but please make it anonymous

No

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* 6. If you win the weekly prize, can we include your name in the prize announcement email?

Yes

No, please keep my name anonymous and email me to let me know I won.