This Girl Can

Why do you want to be a part of This Girl Can Victoria?

What do you do to get active?

How does it make you feel?

How do you prefer to get active? (tick all that apply)

With other people

Alone

With your kids

With your dog

Pick a question to respond to in your video:

Can you tell us about a time you felt self-conscious before, during or after an activity?

Can you tell us about a time when you felt judged when getting active?

What keeps you getting out and getting active?

What would you say to other women who are worried about being judged when getting active?

RECORD OR UPLOAD YOUR VIDEO SUBMISSION

(Max. 3 mins)

To record your video:

Position your phone on a flat surface horizontally (it shakes in your hand)
Turn off any background music/radio
Make sure you’re in a quiet room with good lighting

I agree to this video being used in promotional materials in line with the VicHealth Privacy Policy

Personal Information

Name

Phone number

Suburb

Postcode

Age group

Do you identify as LGBTIQ+? Yes No

Available for filming in February 2020? Yes No

Have you ever appeared in a TV Commercial or ANY kind of advertising before? Or have you been paid to promote a product or service? If yes, please list what it was for & what year. Yes No

Other details

Do you have any children? If so, what are their ages? Yes No

Ages of children

Do you speak a language other than English? If yes, which language? Yes No

Other languages

Are you Aboriginal or Torres Strait Islander? Yes No

Do you have a disability? If so, could you please give us details? Yes No

Details about your disability

If you do a sport or activity in a group, would the other people in the group also be available and willing to take part in this campaign? Yes No

Please share links to your social media accounts:

Facebook

Instagram

Twitter

Other

Where did you hear about this campaign? Advertising In the news Social media From someone you know From VicHealth

Other

Are you willing to get a police check? Yes No

Yes, I’m happy for VicHealth to contact me about This Girl Can

I agree to the Terms and Condition