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C A T C H Kids Club Student Survey

C A T C H Kids Club Student Survey. 2013-2014. Oklahoma State Department of Health Revised 05/06/13. What is your name? _______________ Today’s Date (mm/ dd / yy ): ________ What grade are you in? ___________ How old are you? ________________

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C A T C H Kids Club Student Survey

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  1. CATCHKids Club Student Survey 2013-2014 Oklahoma State Department of Health Revised 05/06/13

  2. What is your name? _______________ Today’s Date (mm/dd/yy): ________ What grade are you in? ___________ How old are you? ________________ Are you a Boy or a Girl? ___________ CATCHKids Club Student Survey

  3. CATCHKids Club Student Survey 2013-2014 1. On most days, how many fruits do you eat? • I do not eat fruits. • 1-2 fruits per day • 3-4 fruits per day • 5 or more fruits per day

  4. CATCHKids Club Student Survey 2013-2014 2. On most days, how many vegetables do you eat? • I do not eat vegetables. • 1-2 vegetables per day • 3-4 vegetables per day • 5 or more vegetables per day

  5. CATCHKids Club Student Survey 2013-2014 3. On most days, how many sweets do you eat? (cake, cookies, candy, ice cream) • I do not eat fruits. • 1-2 fruits per day • 3-4 fruits per day • 5 or more fruits per day

  6. CATCHKids Club Student Survey 2013-2014 4. How many cups of water do you drink every day? • I do not drink water. • 1-3 cups per day • 4-5 cups per day • 6 or more cups per day

  7. CATCHKids Club Student Survey 2013-2014 5. Do you eat breakfast every day? • Yes • No

  8. CATCHKids Club Student Survey 2013-2014 6. I have fun with CATCH games. • Yes • No • I do not know

  9. CATCHKids Club Student Survey 2013-2014 7. I’ve told my family things we do in CATCH Kids Club. • Yes • No

  10. CATCHKids Club Student Survey 2013-2014 8. Which type of milk do you drink? • I do not drink milk. • Skim, fat free or 1%. • Reduced fat (2% milk) • Whole milk • Other (soy, rice, almond, etc) • I do not know

  11. CATCHKids Club Student Survey 2013-2014 9. Which side dish would you order from a fast food restaurant? a. Apple slices b. French fries c. Tater Tots

  12. CATCHKids Club Student Survey 2013-2014 10. Do you play a GO Activity for 30 minutes every day of the week? • Yes • No • I do not know

  13. CATCHKids Club Student Survey 2013-2014 11. Your heart is a • Valve. • Muscle. • Artery. • I do not know

  14. CATCHKids Club Student Survey 2013-2014 12. You know you are playing hard because a. You get cold. b. You move slowly. c. Your heart beats faster. d. I do not know

  15. CATCHKids Club Student Survey 2013-2014 13. Should you warm up and cool down when you exercise? a. Yes, every time b. No c. Yes, sometimes d. I do not know

  16. CATCHKids Club Student Survey 2013-2014 14. What does your body need to grow? a. Movies b. Food c. TV d. Music

  17. CATCHKids Club Student Survey 2013-2014 15. I know what healthy foods are. • Yes • No • I do not know

  18. CATCHKids Club Student Survey 2013-2014 16. Which food item has the most fiber? a. Milk b. Candy c. Beans d. Chicken

  19. CATCHKids Club Student Survey 2013-2014 17. Which food has the most salt? a. Fruit b. Broccoli c. Low fat milk d. French Fries

  20. CATCHKids Club Student Survey 2013-2014 18. At a fast food restaurant you will mostly find a. Low calorie food items b. Unhealthy fats c. Many good nutrients d. High fiber foods

  21. CATCHKids Club Student Survey 2013-2014 19. Which breakfast food has the most fiber? a. Eggs b. Whole-grain cereal c. Bacon

  22. CATCHKids Club Student Survey 2013-2014 20. How many cups of water should you drink every day? • I should not drink any water. • 1-3 cups • 4-5 cups • 6-8 cups

  23. CATCHKids Club Student Survey 2013-2014 21. An unhealthy food choice is called a • GO Food • NO Food • WHOA Food • I do not know

  24. CATCHKids Club Student Survey 2013-2014 22. When I ask my family to buy healthy foods • They always buy them • They sometimes buy them • They never buy them • I do not ask

  25. CATCHKids Club Student Survey 2013-2014 23. When I am at home • I feel safe playing Go Activities outside • I do not feel safe playing Go Activities outside

  26. CATCHKids Club Student Survey 2013-2014 24. When I am at home • I like to play Go Activities • I do not like to play Go Activities

  27. CATCHKids Club Student Survey 2013-2014 25. When I am at home • I have a place to play Go Activities • I do not have a place to play Go Activities

  28. CATCHKids Club Student Survey 2013-2014 26. When I am at home • I have someone to play Go Activities with • I do not have anyone to play Go Activities with

  29. CATCHKids Club Student Survey 2013-2014 27. When I am at home • I am encouraged to play Go Activities • I am not encouraged to play Go Activities

  30. Use the following nutrition label to answer questions 28-30.

  31. CATCHKids Club Student Survey 2013-2014 28. How many milligrams (mg) of sodium does this food have? • 20 mg • 44 mg • 440 mg • I do not know

  32. CATCHKids Club Student Survey 2013-2014 29. Is this food a good source of fiber? • Yes • No • I do not know

  33. CATCHKids Club Student Survey 2013-2014 30. Is this food a healthy food choice? • Yes • No • I do not know

  34. CATCHKids Club Student Survey • Be sure put your first and last name on the answer sheet. • Send the answer sheets to: • Oklahoma State Department of Health • CATCH Program, Community Development Service • 1000 NE 10th Street, Room 508 • Oklahoma City, OK 73117 2013-2014 Oklahoma State Department of Health Revised 05/06/13

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