Student Survey- Movement in the Classroom

By completing this survey about movement in your life, you will help me
learn more about you! It is your choice to complete these questions. Please
be honest. Thanks for your help!

#: __________
Answer the Following Questions:
1. Have you ever participated in movement activities or brain breaks in
another class?
Yes
o
o
o
o
o
o
o
o
o
o
No

Kindergarten
First grade
Second grade
P.E.
Spanish
Music
Library
Art
Technology
Other:
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2. Do you like using movement at school? Why or why not?

Yes because

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No because

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3. What is your favorite activity to play at recess?

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4. Do you use movement at home?
Yes
o What do you do?

_______________________________________________

______________________________________________
______________________________________________
______.
No
5. Do you participate in any activities outside of school that use
movement?
Yes
o
o
o
o
o
o
o

Soccer
Football
Baseball
Dance
Cheerleading
Gymnastics
Other: _________________________________________

No
6. What do you usually do when you get home from school?

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7. Circle all the movement that you use at home:

Walk the dog/play with a pet

Walk to the bus stop
Play Wii games that let you move (like Wii bowling!)
Clean the dishes
Clean your room
Vacuum the house
Jumping on the bed or couch
Building a fort
Roller skating
Walking up and down stairs
Stretching
Gardening
Swimming
Playing tag
Playing hide-and-seek
Climbing trees
Help cook
Give a pet a bath
Other:
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