Child Obesity in California

Childs Gender

Boy

Girl

Childs Age

0-2

3-5

6-8

Is your child interested in any activities?

Yes

No

How satisfied are you with the following:

Do you make lunch for your child or he/she buys lunch at school?

Takes lunch from home

Buys lunch at school

How many hours does your child watch TV?

0-2

2-4

4-6

more

Any health problems in the family? Explain.

Is your child(select all that relate):

Sociable

Quiet

Sad most of the time

Upset

Would you be interested in receiving general information on healthy eating and physical activity in childhood and adolescence?

yes

no

Can you provide us with an email address: