You are on page 1of 6

1

ParentQuestionnaire
Pleasenote: thisquestionnairewilltakeapproximately10minutestocomplete
pleaseanswerthequestionsinrelationtothechildnamedabove
please completeeverylineinthequestionnaire
Forfurtherinformation,pleasecontact:
CHILDRENSPHYSICALACTIVITYQUESTIONNAIRE(CPAQ)
Yourchildsname:
Yourchildsdateofbirth(dd/mm/yy)://
Areyouthechilds:mother/father/guardian/other
2
Pleasecompletethisquestionnaireforthefollowingdays:to
MONDAYFRIDAY SATURDAY SUNDAY
DidyourCHILDdothefollowingactivities
inthe past7days?
Howmanytimes
MonFri?
Totalhours/minutes
MonFri?
HowmanytimesSat
Sun?
Total
hours/minutesSat
Sun?
EXAMPLE:
Bikeriding No Yes 2 40mins 1 15mins
SPORTSACTIVITIES
Aerobics No Yes
Baseball/softball No Yes
Basketball/volleyball No Yes
Cricket No Yes
Dancing No Yes
Football No Yes
Gymnastics No Yes
Hockey(fieldorice) No Yes
Martialarts No Yes
Netball No Yes
Rugby No Yes
WhichofthefollowingPHYSICALactivitiesdidyourchilddointhePAST7DAYS?
3
MONDAYFRIDAY SATURDAY SUNDAY
DidyourCHILDdothefollowingactivities
inthe past7days?
Howmanytimes
MonFri?
Totalhours/minutes
MonFri?
HowmanytimesSat
Sun?
Total
hours/minutesSat
Sun?
Runningorjogging No Yes
Swimminglessons No Yes
Swimmingforfun No Yes
Tennis/badminton/squash/
otherracquetsport
No Yes
LEISURETIMEACTIVITIES
Bikeriding(notschooltravel) No Yes
Bounceonthetrampoline No Yes
Bowling No Yes
Householdchores No Yes
Playinaplayhouse No Yes
Playonplaygroundequipment No Yes
Playwithpets No Yes
Rollerblading/rollerskating No Yes
Scooter No Yes
4
MONDAYFRIDAY SATURDAY SUNDAY
DidyourCHILDdothefollowingactivities
inthe past7days?
Howmanytimes
MonFri?
Totalhours/minutes
MonFri?
HowmanytimesSat
Sun?
Total
hours/minutesSat
Sun?
Skateboarding No Yes
Skiing,snowboarding,sledging No Yes
Skippingrope No Yes
Tag No Yes
Walkthedog No Yes
Walkforexercise/hiking No Yes
ACTIVITIESATSCHOOL
Physicaleducationclass No Yes
Travelbywalkingtoschool(toandfrom
school=2times)
No Yes
Travelbycyclingtoschool(toandfrom
school=2times)
No Yes
OTHER
pleasestate:
No Yes
5
DidyourCHILDdothefollowingactivities
inthe past7days?
MONDAYFRIDAY
Totalhours/minutes
SATURDAYSUNDAY
Totalhours/minutes
EXAMPLE:
WatchingTV/videos No Yes 15hrs 6hrs30mins
Art&craft(eg.pottery,sewing,drawing,
painting)
No Yes
Doinghomework No Yes
Imaginaryplay No Yes
Listentomusic No Yes
Playindoorswithtoys No Yes
Playingboardgames/cards No Yes
Playingcomputergames(e.g.playstation/
gameboy)
No Yes
Playingmusicalinstrument No Yes
Reading No Yes
Sittingtalking No Yes
Talkonthephone No Yes
Travelbycar/bustoschool(toandfrom
school)
No Yes
6
DidyourCHILDdothefollowingactivities
inthe past7days?
MONDAYFRIDAY
Totalhours/minutes
SATURDAYSUNDAY
Totalhours/minutes
Usingcomputer/internet No Yes
WatchingTV/videos No Yes
Other(pleasestate): No Yes