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What age is your child?
 
7 years old
 
8 years old
 
9 years old
 
10 years old
 
11 years old
 
 
 
Where do you live?
 
Rural area/village
 
Town
 
City
 
 
 
Out of school approximately how long does your child spend outside on a weekday? (Monday – Friday)
 
0-1 hours
 
1-2 hours
 
2-3 hours
 
3+ hours
 
 
 
On an average weekend how long does your child spend outdoors?

 
0-3 hours
 
3-6 hours
 
6-9 hours
 
9-12 hours
 
12+ hours
 
 
On a scale of 1-10 (where 1 is not at all and 10 is very) how beneficial do you feel being outdoors is to your child’s learning?
1 2 3 4 5 6 7 8 9 10
*
 
 
On a scale of 1-10 (where 10 is very and 1 is not at all) how safe would you/do you feel letting your child play unsupervised, away from your home?
1 2 3 4 5 6 7 8 9 10
*
 
 
 
In your household how many TVs do you have?
 
0
 
1
 
2
 
3
 
4+
 
 
 
On average how long does your child spend watching television on a weekday? (Monday – Friday)
 
0-1 hours
 
1-2 hours
 
2-3 hours
 
3+ hours
 
 
 
On an average weekend how long does your child spend watching television?
 
0-3 hours
 
3-6 hours
 
6-9 hours
 
9-12 hours
 
12+ hours
 
 
 
In your household how many computers/laptops do you have?

 
0
 
1
 
2
 
3
 
4+
 
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