Questionnaire to Parents

7/31/2019 Questionnaire to Parents

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QUESTIONNAIRE TO PARENTS

You and your children are our customers, and as such are of paramount importance to us. We would

very much appreciate it if you would take the time to complete the following questionnaire. It is not

compulsory to add your name or your child's details to this questionnaire.

Please circle your responses.

1. Does your child use the school canteen? Yes No

If so, for which break? Breakfast Break Lunch All 3

2. Do you ask your child what they have eaten during the day? Yes No Sometimes

3. Are you concerned with what your child eats during the school day? Yes No

4. Are you concerned about the nutritional value of your child's diet? Yes No

5. If only a fully nutritional balanced meal (this means no junk food will be available) was offered to

your child each day, would you be prepared to pay for this? Yes No MaybeAny other comments?..........................................................................................................................

6. Would you like to know what your child has eaten during the school day? Yes No

7. How much money per day do you give to your child to purchase? (please specify)

Breakfast Break snacks

Lunch On the way to school

On the way home

8. Is dinner money security an issue to you or your child? Yes No

If so please give details...

9. Do you know if your child stops on the way to or from school to purchase food products? Yes No

If so please give details:.................................................................................................................

10. OPTIONAL QUESTIONDoes your child receive a free school meal? Yes No

If so does your child always use their ticket? Yes No

If not please state the reason.........................................................................................................

11. Does your child have a favourite meal? Yes No

If so please specify

12. Does your child eat breakfast at home in the mornings? Yes No

If so please give details of a typical breakfast.................................................................................

13. Has your child got any special dietary needs? Please indicate and continue overleaf is required

Religious (i.e. Kosher, Halal) Vegetarian

Allergy Vegan

Health Other, please specify


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14. How many times per week does your child eat a take-away meal? ..

15. How many times per week does your child eat out at a cafe or restaurant? .

16. Does your child eat a meal along with the rest of the family? Yes No Sometimes

17. Where does your child generally eat his/her evening meal?................................................................

18. Where does your child generally eat his/her breakfast?.......................................................................

19. Do you find yourself cooking an alternative meal for your child compared to the rest of the family?

Yes No Sometimes

20. Do you insist that your children eat exactly what the rest of the family is eating? Yes No

21. Do you provide your child with a packed lunch? Yes No

If so, what does this generally consist of?..........................................................................................

If so, why have you chosen this alternative?...................................................................................

22. Does childhood obesity affect your family? Yes No

23. Is you child affected by any other form of eating disorder, if so please specify?..................................

24. Do you purchase organic food? Yes No Sometimes

25. Any other comments or

suggestions


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Questionnaire 2

This set of questions is about your childrens eating habits and physical activity. The firstfew questions ask about food, and the rest of the questions should be answered for each of

the children in your household. Your participation in this survey is voluntary and allanswers will be kept confidential. If there is a question that you do not wish to answer, youcan skip it and move on to the next question. We are hoping that the information we getfrom this survey will help us understand the eating behaviors of children in our community

Please indicate whether you strongly agree, somewhat agree, somewhat disagree, orstrongly disagree with the following statements:

1. Some people are born to be fat and some thin; there is not much you can do to changethis.

1 Strongly agree 2 Somewhat agree 3 Somewhat disagree 4 Strongly disagree

2. What you eat can make a big difference in your chance of getting a disease, like heartdisease or cancer.

1 Strongly agree 2 Somewhat agree 3 Somewhat disagree 4 Strongly disagree

When you buy food, how important is each of the following?

3. How safe the food is to eat 1 Veryimportant

2 Somewhat

important

3 Not too

important

4 Not at all

important

4. Nutrition (how healthy thefood is)

1 Very

important

2 Somewhat

important

3 Not too

important

4 Not at all

important

5. Price 1 Veryimportant

2 Somewhat

important

3 Not too

important

4 Not at all

important

6. How well the food keeps 1 Veryimportant

2 Somewhat

important

3 Not too

important

4 Not at all

important

7. How easy the food is toprepare

1 Very

important

2 Somewhat

important

3 Not too

important

4 Not at all

important

8. Taste (whether child likesthe food) 1 Very 2 Somewhat 3 Not too 4 Not at all


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important important important important

In your opinion, how important are the following things are to a childs present and future

health?

9. What a child eats 1 Veryimportant

2 Somewhat

important

3 Not too

important

4Dont know

10.How much a child eats 1 Veryimportant

2 Somewhat

important

3 Not too

important

4Dont know

11.How much exercise achild gets

1 Very

important

2 Somewhat

important

3 Not too

important

4Dont know

12.What the child weighs 1 Veryimportant

2 Somewhat

important

3 Not too

important

4Dont know

Please answer the following questions for each of your children:

Child 1 Child 2 Child 3 Child 4

13.Sex 1 Male

2 Female

1 Male

2 Female

1 Male

2 Female

1 Male

2 Female

14.Age______ years

old

______ years

old

______ years

old

______ years

old

15.Height(in feet &

inches) _____ ft _____

in

_____ ft _____

in

_____ ft _____

in

_____ ft _____ in


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16.Weight(in pounds)

____ ____ ____

lbs

____ ____ ____

lbs

____ ____ ____

lbs

____ ____ ____

lbs

17.Not countingjuice, how oftendo yourchildren ages 2and over eatfruit on anaverage day?

1 Never or

rarely

2 1 helping

3 2-3

helpings

4 4 or more

helpings

5Dont

know/ not

sure

1 Never or

rarely

2 1 helping

3 2-3

helpings

4 4 or more

helpings

5Dont

know/ not

sure

1 Never or

rarely

2 1 helping

3 2-3

helpings

4 4 or more

helpings

5Dont

know/ not

sure

1 Never or

rarely

2 1 helping

3 2-3

helpings

4 4 or more

helpings

5Dont

know/ not

sure

18.On an averageday, how oftendoes each childeat vegetables?(Includesvegetablesalad..)

1 Never or

rarely

2 1 helping

3 2-3

helpings

4 4 or more

helpings

5Dont

know/ not

sure

1 Never or

rarely

2 1 helping

3 2-3

helpings

4 4 or more

helpings

5Dont

know/ not

sure

1 Never or

rarely

2 1 helping

3 2-3

helpings

4 4 or more

helpings

5Dont

know/ not

sure

1 Never or

rarely

2 1 helping

3 2-3

helpings

4 4 or more

helpings

5Dont

know/ not

sure


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19.How manytimes a weekdoes each child

eat fast food(McDonalds,Wendys, TacoBell, etc.)

1 Never or

rarely

2 1-2 times

3 3-4 times

4 5 or more

times

5Dont

know/ notsure

1 Never or

rarely

2 1-2 times

3 3-4 times

4 5 or more

times

5Dont

know/ notsure

1 Never or

rarely

2 1-2 times

3 3-4 times

4 5 or more

times

5Dont

know/ notsure

1 Never or

rarely

2 1-2 times

3 3-4 times

4 5 or more

times

5Dont

know/ notsure

20.How manysodas per week

does each childdrink?

1 Never or

rarely

2 1-4 sodas

3 5-7 sodas

4 8 or more

sodas

5Dont

know/ not

sure

1 Never or

rarely

2 1-4 sodas

3 5-7 sodas

4 8 or more

sodas

5Dont

know/ not

sure

1 Never or

rarely

2 1-4 sodas

3 5-7 sodas

4 8 or more

sodas

5Dont

know/ not

sure

1 Never or

rarely

2 1-4 sodas

3 5-7 sodas

4 8 or more

sodas

5Dont

know/ not

sure


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21.How manytimes per weekdoes each child

play or exerciseenough tomake him/hersweat andbreathe hardfor 20 or moreminutes?

1 Never or

rarely

2 1-2 times

3 3-4 times

4 5 or more

times

5Dont

know/ notsure

1 Never or

rarely

2 1-2 times

3 3-4 times

4 5 or more

times

5Dont

know/ notsure

1 Never or

rarely

2 1-2 times

3 3-4 times

4 5 or more

times

5Dont

know/ notsure

1 Never or

rarely

2 1-2 times

3 3-4 times

4 5 or more

times

5Dont

know/ notsure


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22.How wouldyou describeeach childs

weight?

1 Very

underweigh

t

2 Slightly

underweigh

t

3 About the

right weight

4 Slightly

overweight

5 Very

overweight

1 Very

underweigh

t

2 Slightly

underweigh

t

3 About the

right weight

4 Slightly

overweight

5 Very

overweight

1 Very

underweigh

t

2 Slightly

underweigh

t

3 About the

right weight

4 Slightly

overweight

5 Very

overweight

1 Very

underweigh

t

2 Slightly

underweigh

t

3 About the

right weight

4 Slightly

overweight

5 Very

overweight

23.About howmany hoursdo youestimate eachof your

children sitand watch TVor videos onan averageschool day?

1 Less than 1

hour

2 1-2 hours

3 3-4 hours

4 5 or more

hrs

5 None

6 Dont know

1 Less than 1

hour

2 1-2 hours

3 3-4 hours

4 5 or more

hrs

5 None

6 Dont know

1 Less than 1

hour

2 1-2 hours

3 3-4 hours

4 5 or more

hrs

5 None

6 Dont know

1 Less than 1

hour

2 1-2 hours

3 3-4 hours

4 5 or more

hrs

5 None

6 Dont know

Thank you for completing this survey.

Documents

Questionnaire to Parents