Sample Survey Questionnaires Your Child's Activities At Home: Parent Survey ]
CHILD'S NAME: __________________________________________________AGE: ____________
1. Approximately how much time does your child spend reading at home?
2. What does he/she read?
3. Does your child use a computer at home?
4. If so what do they use it for?
5. Does your child watch TV at home?
6. If so, what programs does he/she like?
7. If your child uses electronic games, what games are they?
8. What sports does your child play?
9. Does your child read about her/his sports?
10. At home how much time each day does your child spent on:
a) computer
b) electronic games
c) sports
d) watching TV
e) reading
11. Please add comments about any of these activities and any concerns you might have.