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Exit Survey
 
 
Are you...
 
Single
 
Divorced
 
Seperated
 
Married
 
Other
 
 
 
 
Gender
 
Male
 
Female
 
 
 
Do you have children?
 
Yes
 
No
 
 
 
How many children do you have?
 
 
What age range does each child fall under?
1-3 4-6 7-9 10-12 13-15 16-18
Child 1
Child 2
Child 3
Child 4
Child 5
Child 6
Child 7
 
 
Which devices is there in the house and which devices do the children have personally?
House Personal
Television
Computer
Laptop
Tablet
Mobile phone
None
 
 
How many hours a week does your child get with each device?
Television Computer Laptop Mobile phone Tablet
Up to 2
3-5
6-8
9-12
13-15
16-18
20+
 
 
What age did your child get their own device?
Child 1 Child 2 Child 3 Child 4 Child 5 Child 6 Child 7
Age 1
Age 2
Age 3
Age 4
Age 5
Age 6
Age 7
Age 8
Age 9
Age 10
Child 1 Child 2 Child 3 Child 4 Child 5 Child 6 Child 7
Age 11
Age 12
Age 13
Age 14
Age 15
Age 16
Age 17
Age 18
 
 
 
Do your children use their devices at school?
 
Yes
 
No
 
 
 
What types of physical activity are your children involved in?
 
Organized play
 
Unstructured play
 
Outdoor play (parks, swimming, backyard...)
 
City sports
 
School sports
 
None