Parent/ Guardian Questionnaire

Section 1: About Your Family and Your Household

In this questionnaire the terms ‘father’ and ‘mother’ refer to the child’s biological parents if they live in the household, or their step-parents/guardians otherwise

1. This questionnaire is being completed by:

Mother

Father

Other (e.g. male guardian, please describe)....................

2. What is the postcode for your home address?

__ __ __ __ __ __ __

3. How many people live in your household? (including yourself and children)

______

4. How many children in each of the age bands are there in your household (please also include child participating in the study)? Please write a number in each box.

___ 0-3 years

___ 4-6 years

___ 7-11 years

___ 12-16 years

5. Do you own or have access to a car?

Yes

No

6. Do you rent or own your home?

Own it/buying it

Rent it

Living with relatives/ landlord