Questionnaire – Grades 4 to 8 2006/07

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The province of your school:

  1. How many people usually live in your household*? 
    Don’t forget to count yourself in! _____
    *Note: Your household means your home. If you live in more than one home, choose the one in which you spend the most time. The term “household” is used in the Census of Canada.
  2. What language do you most often speak at home? Choose one:
    • English
    • French
    • Spanish
    • Chinese
    • Punjabi
    • Arabic
    • German
    • Italian
    • Portuguese
    • Polish
    •  Urdu
    • Vietnamese
    • Tagalog (Filipino)
    • Hindi
    • Persian (Farsi)
    • Cree
    • Tamil
    • Russian
    • Korean
    • Greek
    • Other
  3. Are you male or female? _____
  4. What is your date of birth? Use digits only, year and month ______ yyyy ______mm
  5. What is your age in years? _____ years
  6. What is your height, without shoes, in centimetres? ______ cm
  7. What is your arm span in centimetres? (Open arms wide, measure distance from tip of right hand middle finger to tip of left hand middle finger.) ______ cm
  8. What is the length of your right forearm, from your elbow bone to your wrist bone, in centimetres? ______cm
  9. What is your wrist circumference in millimetres? _____mm
  10. What is the length of your right hand from your wrist bone to the tip of the middle finger, in centimetres? _____cm
  11. What is the length of your right foot, without a shoe, in centimetres? _____cm
  12. What colour are your eyes?
    • Blue • Brown • Green • Other
  13. Do you have allergies?
    • Yes • No
  14. In most activities, which are you?
    • Left-handed • Right-handed • Ambidextrous
    (Note: The following question can only be answered using the online questionnaire. To practice, click here. (Link to testing area.)
  15. How fast is your reaction time?
    Click ‘Start’. When the words “Press Stop” appear in the box, click ‘Stop’ as fast as you can.
  16. What do you usually have for breakfast? Choose all the groups that apply:
    • Grain products: (e.g., bread, cereal, toast, muffin, bagel, rice, pasta)
    • Milk products: (e.g., milk, cheese, yogurt)
    • Vegetables and fruits: (e.g., juice, bananas, oranges, carrots, tomatoes)
    • Meat and alternatives: (e.g., eggs, bacon, chicken, peanut butter, beans)
    • Other: (e.g., tea, coffee, pop, chips, cookies, donuts)
    • No breakfast
  17. In the last 24 hours, approximately how much time did you spend, to the nearest hour, on each of the following activities? Make sure that the total does not add up to more than 24 hours.
    Playing computer or video games ____hours
    Reading (not school work) ____ hours
    Watching TV, videos or movies ____ hours
    Playing or listening to music ____ hours
    Playing board or card games ____ hours
    Participating in organized sports ____ hours
    Participating in other hobbies ____ hours
    Doing homework ____ hours
    Talking with friends ____ hours
    Sleeping ____ hours
  18. How much pressure do you feel because of the schoolwork you have to do? Choose one:
    • none • very little • some • a lot
  19. What is your favourite physical activity to participate in? Choose one:
    • hiking or walking • running or jogging • cycling • swimming • ice skating
    • skiing • snowboarding • hockey • tennis • badminton • baseball
    • basketball • football • volleyball • rugby • soccer • fencing • karate or other martial art • skateboarding
    • inline skating • dance or drama
    • other • none
  20. On how many days last week did you do a physical activity that made you huff and puff or made you feel out of breath, tired or warmer than usual? Choose one:
    • 0 • 1 • 2 • 3 • 4 • 5 • 6 • 7
  21. How do you usually travel to school? Choose one:
    • walk • skateboard • inline skate • bicycle • motorcycle • moped • bus
    • car • train • subway or metro • other
  22. How long does it usually take you to travel to school? _____ minutes
  23. What is your favourite subject at school? Choose one:
    • art • English • French • social studies • history • geography • math
    • science • computers • music • physical education • other
  24. In the last month, how many times have you been bullied* at school? Choose one:
    • 0 • 1 to 3 • 4 to 9 • 10 or more
    * Note: Being bullied means when someone does or says something to make you feel uncomfortable or afraid
  25. Do you have any of the following? Choose 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 • your own MP3 or mini disc player
  26. Which of the following pets do you have? Choose all that apply:
    • bird • cat • dog • fish • gerbil • guinea pig • hamster • rabbit • reptile
    • no pet • other
  27. If you had $1,000 to donate to a charity of your choice, what type of organization would you choose? Choose one:
    • Arts, culture, sports (e.g., community centres, museums, sports teams, music programs)
    • Health (e.g., cancer, AIDS, diabetes research)
    • Religious (e.g., church or activities related to worship)
    • Environment (e.g., saving forests, clean air, clean water)
    • Wildlife, animals (e.g., endangered species, prevention of cruelty to animals)
    • Education / Youth development (e.g., reading, literacy and skills training, after-school programs)
    • International aid (e.g., disaster relief, health, education and food aid in poor countries)
    • Other
  28. 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