The province of your school: 
1. How many students are in your class?
2. What is your home postal code?
Write the first three characters.
3. How many people usually live in your household?
Don’t forget to count yourself in!
4. Are you male or female?
5. What is your date of birth? mm yyyy
Use digits only, month and year
6. What is your age in years?
7. What is your height in centimetres without shoes?
8. What is your hand span in centimetres?
9. What is your wrist circumference in millimetres?
10. What is your foot length in centimetres, right foot without a shoe?
11. What colour are your eyes? blue, brown, green, other
12. Do you have allergies? yes, no
13. What do you usually have for breakfast?
Circle all that apply:
milk, fruit juice, hot beverage, hot cereal, cold cereal, eggs, toast, muffin, bagel, cereal bar, cheese, yogurt, no breakfast, other.
14. When you are thirsty, what do you usually prefer to drink?
Circle one:
water, soft drink, juice, sport drink, milk, chocolate milk, other.
15. In the last week, approximately how much time did you spend on each of the following activities?
(categories: 0, 1 to 3 hours, 4 to 6 hours, 7 to 9 hours, 10 or more hours.)
playing sport
watching live sport
watching sport on T.V.
playing computer sport games
reading about sport
coaching sport
16. In the last two weeks, which of the following activities have you done?
Circle all that apply:
going for a walk, running or jogging, cycling, skating, swimming, soccer, hockey, tennis, baseball, basketball, karate or other martial art, skateboarding, rollerblading, dance or drama, playing computer games, reading, watching T.V. or films.
17. How do you usually travel to school?
Circle one:
walk, skateboard, rollerblade, cycle, motorcycle, car, bus, train, subway or metro, other.
18. How long does it usually take you to travel to school? minutes
19. What is your favourite subject at school?
Circle one:
art, English, French, social studies, history, geography, math, science, computers, music, physical education, other.
20. In the last year, how many times have you been bullied at school?
0, 1 to 3, 4 to 9, 10 or more.
21. How many times in the last week did you drop litter (e.g. candy wrappers) elsewhere than in garbage containers?
0, 1 to 3, 4 to 9, 10 or more.
22. Do you have any of the following?
Circle all that apply:
your own calculator, your own cell phone, your own pager, access to a computer at home, access to the Internet at home.
23. Which of the following pets do you have?
Circle all that apply:
bird, cat, dog, fish, gerbil, guinea pig, hamster, rabbit, reptile, no pet, other.
24. Think about someone you most look up to. This could be someone you know personally or have read about or seen on T.V. From the list below, choose the category that best describes this person.
- relative
- actor
- sportsperson
- coach or club leader
- business person
- religious figure
- politician
- teacher
- doctor or nurse
- musician or singer
- friend
- community leader or elder
- other
