Jordan Kids Toothpaste Recruitment Survey (Database)

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* 1. Personal Information

Full Name:

Beauty Bulletin Username:

Address (Physical Day Time Address):

City:

Postal code:

Email Address:

Contact Number: (Cell Phone Number)

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* 2. Do you have a child/children within the age group 0-12 years old?

Yes

No

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* 3. Please select the age group and gender of your child/children:

Girl: 0-5 years old

Boy: 0-5 years old

Girl: 6-12 years old

Boy: 6-12 years old

If other (please specify the age and gender)

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* 4. Your Race:

Asian

Black

Coloured

Indian

White

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* 5. Are you willing to let your child/children take part in the #KidsLoveJordan toothpaste review project?

Yes

No

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* 6. Do your kids enjoy the taste of their current toothpaste?

Yes

No

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* 7. Is getting your kids to brush their teeth for the full 2 minutes a pleasant experience or an upward battle?

Pleasant experience

Upward battle

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* 8. How likely is it that you would recommend Jordan Kids toothpaste based on your knowledge today, to a friend or colleague?

Not at all likely

Extremely likely

0

1

2

3

4

5

6

7

8

9

10

0

1

2

3

4

5

6

7

8

9

10