Children's Activities

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* 1. Please fill out the following contact information so we may contact you.

Name

Address

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

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* 2. What is your gender?

Male

Female

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* 3. What is your age?

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* 4. Which of the following best describes your household situation?

Single, never married

Living with partner

Married

Divorced/Separated

Widowed

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* 5. Which of these best describes your employment situation?

Employed full-time

Employed part-time

Self-employed

Homemaker

Student

Retired

Not currently employed/ Looking for work

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* 6. Which of the following categories includes your total annual household income before taxes?

Below $50,000

$50,000-$75,000

$75,000-$100,000

$100,00-$150,000

$150,000-$250,000

$250,000-$300,000

$300,000-$400,000

$400,000-$500,000

above $500,000

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* 7. To ensure that we speak to a representative group of people, can you please tell me your race/ethnicity?

White/Caucasian

African American

Asian/Pacific Islander

Hispanic or Latina

Mixed Race

Other (please specify)

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* 8. Please tell us what is the highest level of education that you have attained?

Some high school

High School

Some College

College

Post Graduate

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* 9. Do you or any of your immediate family (parents, brothers, sisters, children) or close personal friends work in any of the following industries or professions?

Marketing or market research company or department

Advertising agency or public relations firm or department

Radio, TV, newspapers, magazines

A company that manufactures, sells, or distributes children’s arts & crafts products, pens, pencils, children’s games or hobby kits

A company that manufactures, sells of distributes children’s clothing, outerwear, shoes, bags, or other apparel

A company that manufactures, sells or distributes sporting equipment or apparel

As an advisor or provider to one of the above companies

None of the above

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* 10. When was the last time you participated in a market research discussion or interview?

Past six months

Over six months

Never

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* 11. What was the topic or topics of the study you last participated in?

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* 12. Please tell us how many children you have living in the household?

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* 13. Please tell us the exact ages and gender of each of your children (for however many children you have)

Child 1

Child 2

Child 3

Child 4

Child 5

Child 6

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* 14. Please tell us if there are any types of arts, crafts or other ‘hands on’ projects OR materials that you won’t allow, or discourage, your child or children (ages 5-10) to do in the home?

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* 15. And thinking about your child’s or children's (ages 5-10) interests and activities in the home, what type of things do you MOST encourage your child to do on a regular basis (pick top 3)

Read books on specific subjects

Coloring/painting/creative activities

Watch educational TV

Free play

Engage in ‘hands-on’ learning/projects

Physical activity

Practice specific skills