Personal Digital Detox Challenge Sign-Up Form

Personal Digital Detox Challenge Sign-Up Form — Form Fields

This personal template includes 10 fields. Sign up for a structured digital detox challenge with defined rules, duration, and personal intentions. Free to customize and use on ZenBuild.

• Your Name (text, required)
• Email Address (email, required)
• Detox Duration (dropdown selection, required) — options: 24 hours, Weekend (2 days), One week, Two weeks, 30 days
• Start Date (text, required)
• Devices/Platforms to Detox From (checkboxes, required) — options: Social media, Smartphone (non-essential use), Streaming video, News sites, Email (personal), Gaming, All screens
• Work Exemption (dropdown selection, required) — options: Yes - work devices/email allowed, No - full detox, Partial - limited work use
• Why are you doing this detox? (long text, required)
• What do you plan to do with the reclaimed time? (long text, optional)
• Accountability partner? (dropdown selection, required) — options: Yes - a friend is joining me, Yes - I have someone checking in on me, No - solo challenge
• Detox motivation level (1-5) (dropdown selection, required) — options: 1, 2, 3, 4, 5