Your Name:

City:

State:

Zip code:

Your Email Address:

Are you a?

Boy

Girl

1.What kind of after school activities do you like?

Dance

Art

Soccer

Basketball

Volley ball

2. Where do you play the most?

Home

School

Relative's house

Community center

Park

3. Do you like to play by yourself or with other children?

By yourself

With other children

4. Do you like to spend time playing with your parents, teacher, or friends?

Parents

Teacher

Friends

5. How many other children play with you?

1 - 3

4 - 6

7 - 10

more than 10

6. Do you share with other children?

Yes

No

7. Sports can sometimes make you feel better about yourself in many different ways. Tell us how sports has helped you?

8. Do you think that you've learned about sharing and teamwork through sports?

Yes

No

9. What have you learned from after-school activities that you can remember?

10. How old are you?

less than 8 years old

9 to 12 years old

13 to 15 years old

16 to 18 years old

11. In your own words, what is the best thing about after school activities?

or