Health Canada Survey

The EAT WELL - BE ACTIVE Winter 2010 Challenge

Once you've successfully completed The EAT WELL - BE ACTIVE Winter 2010 Challenge share your healthy eating and physical activity goals for a chance to WIN a $100 gift card to a sports store in your neighbourhood!
(You must complete the form for your entry to be accepted.)

Contest closes: February 28th, 2010.

Click here to see full Rules and Regulations

Personal Information

First Name:
Last Name:
Age:
Phone Number:	( ) -

1. What was your SMART healthy eating goal? Did you achieve it? If not, why?

2. What was your SMART physical activity goal? Did you achieve it? If not, why?

3. Will you make healthy eating and physical activity part of your everyday life? If not, why?

4. Please submit your parent or guardian's email address:

Check here if you have received permission from a parent or guardian to enter this contest.

Please hit submit only once.