Kids Focus Group- May 2019

Hello and thank you for being a part of the Q-insights database.

We are looking for parents of children under 18 yrs old for a focus group we are conducting on May 29th & May 30th.

The 1.5 hour sessions will be held in Burbank and you will be compensated $135 immediately after the sessions.

If you are interested in participating, please complete this questionnaire.

If you pre-qualify a recruiter will be in touch with you to ask a few additional qualifying questions.

Thank you,

QI-Team

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* 1. What is your gender?

Female

Male

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* 2. What is your age?

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* 3. Do you currently have any children living at home with you?

Yes

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* 4. What are the ages, genders, and grades in school of your children?

	Age	Gender	Grade in School	Type of School
Child 1	Child 1 Age menu	Child 1 Gender menu	Child 1 Grade in School menu	Child 1 Type of School menu
Child 2	Child 2 Age menu	Child 2 Gender menu	Child 2 Grade in School menu	Child 2 Type of School menu
Child 3	Child 3 Age menu	Child 3 Gender menu	Child 3 Grade in School menu	Child 3 Type of School menu
Child 4	Child 4 Age menu	Child 4 Gender menu	Child 4 Grade in School menu	Child 4 Type of School menu
Child 5	Child 5 Age menu	Child 5 Gender menu	Child 5 Grade in School menu	Child 5 Type of School menu

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* 5. How do you connect to the internet? Check all that apply.

Dial-up

Satellite or cable

DSL

Smartphone wifi hotspot or 3G/4G wireless

Other high-speed/broadband connection

Not sure

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* 6. Which of the following TV services do you have in your house?

Cable TV (for example: AT&T U-verse, Spectrum (Charter/Time Warner), Comcast, Cox, Optimum)

Satellite TV (for example: DISH Network, Direct TV)

Telephone Company TV Services (for example, Verizon Fios)

Streaming Media Service (for example: Netflix, Hulu, Amazon Prime, iTunes, Vudu)

Over-the-air antenna

I am not sure

None of the above

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* 7. Which of the following is your TV service provider?

AT&T U-verse

Spectrum (Charter or Time Warner)

Comcast

Cox

Optimum

DISH Network

Direct TV

Other (please specify)

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* 8. Have you ever successfully watched online videos on your computer or mobile device (NOT a phone)?

Yes

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* 9. I'd like to learn a bit about your 8-11 yr old childs television viewing habits, would you say you:

like it/encourage it to some degree

have some restrictions but generally, approve of it

are indifferent regarding it

slightly disapprove of it

strongly disapprove of it

I do not have an 8-11 yr old child

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* 10. In a typical week, approximately how often do your 8-11 yr old child/children watch television? Does he/she watch it 2 days per week or less, 3 to 5 days per week, or 6-7 days per week?

2 days per week or less

3-5 days per week

6-7 days per week

I do not have an 8-11 yr old child

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* 11. Which of the following channels do you currently receive in your home?

Disney Channel

Nickelodeon

Food Network

The CW

Netflix

Discovery Channel

Disney XD

Cartoon Network

I do not receive any of these channels at home

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* 12. Of the following channels I will now read to you, please tell me about how many days per week your 8-11 yr old child/children is watching each channel

	0	1	2	3	4	5 or more
Cartoon	Cartoon 0	Cartoon 1	Cartoon 2	Cartoon 3	Cartoon 4	Cartoon 5 or more
Network	Network 0	Network 1	Network 2	Network 3	Network 4	Network 5 or more
Disney XD	Disney XD 0	Disney XD 1	Disney XD 2	Disney XD 3	Disney XD 4	Disney XD 5 or more
Disney	Disney 0	Disney 1	Disney 2	Disney 3	Disney 4	Disney 5 or more
Channel	Channel 0	Channel 1	Channel 2	Channel 3	Channel 4	Channel 5 or more
The CW	The CW 0	The CW 1	The CW 2	The CW 3	The CW 4	The CW 5 or more
truTV	truTV 0	truTV 1	truTV 2	truTV 3	truTV 4	truTV 5 or more
Discovery Channel	Discovery Channel 0	Discovery Channel 1	Discovery Channel 2	Discovery Channel 3	Discovery Channel 4	Discovery Channel 5 or more
Nickelodeon	Nickelodeon 0	Nickelodeon 1	Nickelodeon 2	Nickelodeon 3	Nickelodeon 4	Nickelodeon 5 or more
Netflix	Netflix 0	Netflix 1	Netflix 2	Netflix 3	Netflix 4	Netflix 5 or more

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* 13. Overall, how often do your 8-11 yr old child/children watch game shows, competition shows, talk shows, or talent shows? Would you say he/she watches them:

Rarely or never

Occasionally or Sometimes

Frequently or Often

I do not have an 8-11 yr old child

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* 14. In which of the following categories does your total annual household income fall?

Under 30,000

Between 30-49,999

Between 50-69,999

Between 70-89,999

Between 90-100,000

Over 100,000

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* 15. Which of the following represents your completed level of formal education?

Have completed some high school

Have a high school diploma

Have completed some college

Have a college degree

Have completed some graduate work

Have a graduate degree or more

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* 16. What is your child’s race or ethnicity?

Black or African-American

Hispanic/Latino

Asian or Asian-American

Native American

Multi-racial

Caucasian

Other

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* 17. Are you currently:

A homemaker

Working full-time

Working part-time

Retired

Unemployed

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* 18. Contact Information

First & Last Name

City/Town

ZIP/Postal Code

Email Address

Phone Number