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Survey

Ms. Nash wants to get to know you! *circle your answers please (-:*

STUDENT NAME:
What are your favorite activities to do in PE? What is the primary language spoken in your
home?
outdoor sports or indoor sports
English
individual sports or team sports
Spanish
ball sports or endurance sports
Other (specify): _________

How many people live in your home? How many siblings do you have?

3 or less None

3-5 1-3

5-8 3-5

8 or more 5 or more

Do you share a room with any of your family Have you ever gotten an injury that
members? prevented you from participating in PE or
other activities?

Yes No Yes No

If so, how many? ______

What traditions do you celebrate with your Have you ever played organized sports?
family?
Yes No

If so, what sport(s) were they?

How long did you play this sport(s)?

1 year or less

2-3 years

3 or more years

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