Age: ..........years old Year Group: .......... 1) Please tick below if you have any of the these devices at home:
Please tick more than one if appropriate. Xbox Xbox 360 Gameboy Play Station 3 Play Station 2 Play Station iPod touch iPod iPad Wii DS DSi Computer/ Laptop
Other, please state ...........................
1b) If you have ticked or stated any electronic device above, please tick below, if you regularly play any of the above?
Please tick appropriate. Yes No
1c) If yes, please state how many hours a week, do you spend on these spend of these electronic devices... ...............hrs. 2) Do you play games that are rated over your age?
E.g. certificate 18
Please tick appropriate ... Yes No
2b) If yes, how many hours a week do you spend playing games that were made for people older than you... ..............hrs. 3) Do you own a mobile phone?
Please tick appropriate... Yes No
3b) If yes, tick how many hours a DAY, you spend on your mobile phone.... ..............hrs.
4) Have you ‘put off’ homework/coursework to use your mobile phone or electronic device?
Please tick appropriate Yes No
4b) If yes, how much do you do that... All the time Sometimes