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, Name:

First Name

Last Name

1. Player’s usual length of engagement with puzzles/games within a 1 hour time frame: *

No engagement

1-10 min.

10-30 min.

30-60 min.

Don’t know

2. Player's current level with puzzles: *

A few pieces

12 pieces

48 pieces

100 pieces or more

Don’t know

3. Games of Interest: *

Connect 4

Trouble

Checkers

Backgammon

Chess

Don't Know

4. Card games of Interest: *

Go Fish

Uno

War

Crazy 8's

Old Maid

Don't Know

5. Physical Games of Interest: *

Football

Basketball

Kickball

Red Light, Green Light

Frisbee

Tag

Don't Know

6. Current Skills: *

Takes turns

Follows the steps of the turns

Plays until game ends

No known game skills

Accepts losing

7. Interest in trying something new: *

Never

Sometimes

Often

Always

Don't Know

8. Engagement with others: *

Never

Sometimes

Often

Always

Don't Know

9. Motivated by the activities themselves (vs. motivated by prizes or to just be finished): *

Never

Sometimes

Often

Always

Don't Know

10. Level of independence with games: *

Never

Sometimes

Often

Always

Don't Know

11. Shows enjoyment while participating (e.g. smiles, laughs, positive comments…) *

Never

Sometimes

Often

Always

Don't Know