Q.1
How old are you?
*
under 13
13-15
16-18
over 18
Q.2
What grade are you in?
*
under 8
9
10
11
12
over 12
Q.3
how many hours of TV do you watch a day?
*
0-1
2-4
4-6
over 6
Q.4
Apart from gym class, how many hours of excersize do you get a week?
*
1-2
3-5
5-7
over 8
Q.5
Apart from school, Which of the following takes up most of your time everyday. If other please explain.
*
Homework
TV/Computer/Electronics
Sports/Excerzie
Other:
Q.6
what is your favourite sport? if other please specify
*
soccer
basketball
football
baseball
hockey
Other:
Q.7
How many hours a day do you spend on the computer?
*
0-2
3-4
5-7
over 8
Q.8
How active is your life style?
*
sedentary
light activity
moderately active
heavily active
intense
Q.9
What is your favourite after school activity? If other please specify
*
sleeping
playing video games
watching tv
using the computer
working out
Other:
Q.10
How many hours of sleep do you get a night?
*
under 5
6-7
8-9
over 10
Q.11
Do you have a balanced diet? (according to your countries food guide)
*
Yes
No
Q.12
On average how many glasses of water do you drink everyday? (standard 8oz glass)
*
0-3
4-7
8-12
13-16
over 17
Q.13
How many times a week do you have fast food?
*
0
1-2
3-4
5-7
everyday
over 10
Q.14
How many times a week do you have breakfast
*
0
1-2
3-4
5-6
everyday
Q.15
On average are you stressed?
*
Yes
No
Q.16
What is Your gender?
male
Female