|
Last name |
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|
First name |
|
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Are you 8 years or older? |
Yes / No |
|
School |
|
|
Class |
|
|
Country |
Yes / No |
|
|
Year |
Month |
Day |
|
Birth date |
_ _ _ _ |
_ _ |
_ _ |
|
Date of completing the questionnaire |
_ _ |
_ _ |
_ _ |
| Country | Adult's city of birth | Month of birth of adult | Last 4 digits of phone number | Child code (A,B,C) |
|---|---|---|---|---|
|
_ _ _ _ _ _ _ _ |
_ _ _ _ _ _ _ _ |
_ _ |
_ _ _ _ |
_ |
| Country | Adult's city of birth | Month of birth of adult | Last 4 digits of phone number | Child code (A,B,C) |
|---|---|---|---|---|
|
_ _ _ _ _ _ _ _ |
_ _ _ _ _ _ _ _ |
_ _ |
_ _ _ _ |
_ |
*repetition of the code so that the front page can be detached from the questionnaire
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Not true at all | Not true | Sometimes true | True | Totally true |
|---|---|---|---|---|---|
| 1. In the swimming pool I like to be active or to play | |||||
| 2. I understand the benefits of being active or to play in the swimming pool |
| Not true at all | Not true | Sometimes true | True | Totally true |
|---|---|---|---|---|
| Not true at all | Not true | Sometimes true | True | Totally true |
|---|---|---|---|---|
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Have you ever done this |
YES | NO |
Do you think you can do this ? |
YES | NO |
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Have you ever done this task ? |
YES | NO |
How good do you think you can do this task ? |
| Not good at all | Not so good | So so (not good, not bad) | Good | Very good | I don't dare |
|---|---|---|---|---|---|
| X |