Kids TV Market Research Study Hello, Thank you for signing up with the Q-insights database. We are currently conducting a market research study in regards to the t.v and t.v programs you and/ your child watches. The study will take place in Burbank. The dates will be determined based on what you and/or your child qualify for. If you are interested, please fill out the questionnaire below. Question Title * 1. Do you have any children between the ages of 6-9 years old? 6 7 7 8 9 None of this age Son Son 6 Son 7 Son 7 Son 8 Son 9 Son None of this age Daughter Daughter 6 Daughter 7 Daughter 7 Daughter 8 Daughter 9 Daughter None of this age Question Title * 2. What is your child’s birthday? Question Title * 3. How often would you say your child does the following things? Everyday 3-5 times per week Twice a week Once a week Rarely Never Goes online, at home Goes online, at home Everyday Goes online, at home 3-5 times per week Goes online, at home Twice a week Goes online, at home Once a week Goes online, at home Rarely Goes online, at home Never Reads Reads Everyday Reads 3-5 times per week Reads Twice a week Reads Once a week Reads Rarely Reads Never Plays Sports Plays Sports Everyday Plays Sports 3-5 times per week Plays Sports Twice a week Plays Sports Once a week Plays Sports Rarely Plays Sports Never Listens to music Listens to music Everyday Listens to music 3-5 times per week Listens to music Twice a week Listens to music Once a week Listens to music Rarely Listens to music Never Watches TV Watches TV Everyday Watches TV 3-5 times per week Watches TV Twice a week Watches TV Once a week Watches TV Rarely Watches TV Never Plays video games Plays video games Everyday Plays video games 3-5 times per week Plays video games Twice a week Plays video games Once a week Plays video games Rarely Plays video games Never Question Title * 4. Which, if any, of the following electronic devices do you have in your household that your child uses on a regular basis? My child does not regularly use one There is one that my child regularly uses but it is not his/hers My child has his/her own Computer/Laptop Computer/Laptop My child does not regularly use one Computer/Laptop There is one that my child regularly uses but it is not his/hers Computer/Laptop My child has his/her own Computer/Laptop Computer/Laptop iphone iphone My child does not regularly use one iphone There is one that my child regularly uses but it is not his/hers iphone My child has his/her own iphone iphone Android Phone Android Phone My child does not regularly use one Android Phone There is one that my child regularly uses but it is not his/hers Android Phone My child has his/her own Android Phone Android Phone Other Smartphone Other Smartphone My child does not regularly use one Other Smartphone There is one that my child regularly uses but it is not his/hers Other Smartphone My child has his/her own Other Smartphone Other Smartphone Cell phone (not a smartphone) Cell phone (not a smartphone) My child does not regularly use one Cell phone (not a smartphone) There is one that my child regularly uses but it is not his/hers Cell phone (not a smartphone) My child has his/her own Cell phone (not a smartphone) Cell phone (not a smartphone) Tablet Tablet My child does not regularly use one Tablet There is one that my child regularly uses but it is not his/hers Tablet My child has his/her own Tablet Tablet e-reader e-reader My child does not regularly use one e-reader There is one that my child regularly uses but it is not his/hers e-reader My child has his/her own e-reader e-reader Handheld video game system (i.e. PSP/DS) Handheld video game system (i.e. PSP/DS) My child does not regularly use one Handheld video game system (i.e. PSP/DS) There is one that my child regularly uses but it is not his/hers Handheld video game system (i.e. PSP/DS) My child has his/her own Handheld video game system (i.e. PSP/DS) Handheld video game system (i.e. PSP/DS) Video game console (i.e. Xbox, Wii, Playstation) Video game console (i.e. Xbox, Wii, Playstation) My child does not regularly use one Video game console (i.e. Xbox, Wii, Playstation) There is one that my child regularly uses but it is not his/hers Video game console (i.e. Xbox, Wii, Playstation) My child has his/her own Video game console (i.e. Xbox, Wii, Playstation) Video game console (i.e. Xbox, Wii, Playstation) Question Title * 5. Which best describes you/and your child's ancestry or racial heritage? Asian Black/African American Native American (American Indian pr Alaska Native) Native Hawaiian or other Pacific Islander White/Caucasian Hispanic/Latino Question Title * 6. Which of the following income categories best fits your total annual household income before taxes? $19,999 or less $20,000-$34,999 $35,000-$44,999 $45,000-$54,999 $55,000-$64,999 $65,000-$74,999 $75,000-$99,999 $100,000-$149,999 $150,000 or more Question Title * 7. Please enter contact information so one of our recruiters can contact you should you pre-qualify. Name * Email address * Phone number * Alternate phone number Done