Game Time! Pre-GameSurvey

Player's Name: *

First Name

Last Name

Today's Date: *

MM

DD

YYYY

If form is completed by someone other than the player, your name:

First Name

Last Name

1. How long will you play a game or puzzle? *

Not at all

1-10 min.

10-30 min.

30-60 min.

Don’t know

2. What size puzzle do you like? *

A few pieces

12 pieces

48 pieces

100 pieces or more

Don’t know

3. What games do you like to play *

Connect 4

Trouble

Checkers

Backgammon

Chess

Don't Know

4. What card games do you like to play *

Go Fish

Uno

War

Crazy 8's

Old Maid

Don't Know

5. What game skills do you have? *

I follow the steps of my turn

I take turns

I play until the game ends

I accept losing

I have no current game skills

Don't know

6. Are you interested in trying something new? *

Never

Sometimes

Often

Always

Don't Know

7. Are you interested in playing with others? *

Never

Sometimes

Often

Always

Don't Know

8. Do you like playng games for fun? (vs. motivated by prizes or to just be finished): *

Never

Sometimes

Often

Always

Don't Know

9. Do you play games independently? *

Never

Sometimes

Often

Always

Don't Know

10. Do you show others that you like playing with them?(e.g. smiles, laughs, positive comments…) *

Never

Sometimes

Often

Always

Don't Know

11. We meet many people who are lonely so if you're comfortable, please share your feelings. How often do you feel lonely?

Never

Sometimes

Often

Always

Don't Know