LEISURE INTEREST SURVEY - Temple University
[pic] LEISURE INTEREST SURVEY
| | | |
|Name: |Age: |Date: |
| | |
|Recreation Therapist: |Parent/Guardian/Staff: |
| |
|Please mark an "x" next to the activities that best describe your community leisure interests. |
|Additional items may be added to the list according to your interests. |
|ACTIVITY |HAVE DONE |CURRENTLY DO |INTERESTED |
| |IN PAST | |IN DOING |
|Engaging in Team Sports |
|Basketball | | | |
|Softball/Baseball | | | |
|Soccer | | | |
|Football | | | |
|Hockey | | | |
|Bowling | | | |
|Volleyball | | | |
|Other (please specify): | | | |
|Other (please specify): | | | |
|Engaging or Observing Individual Sports |
|Jogging/Running | | | |
|Swimming | | | |
|Bike Riding | | | |
|Walking | | | |
|Tennis/Ping Pong | | | |
|Darts | | | |
|Golf | | | |
|Badminton | | | |
|Croquet | | | |
|Bocce | | | |
|Horseback Riding | | | |
|Fishing | | | |
|Gymnastics | | | |
|Other (please specify): | | | |
|Other (please specify): | | | |
|Music |
|Singing | | | |
|Playing Instrument | | | |
|Attending Concerts | | | |
|Listening to Radio/Stereo | | | |
|Other (please specify): | | | |
|Other (please specify): | | | |
|ACTIVITY |HAVE DONE |CURRENTLY DO |INTERESTED |
| |IN PAST | |IN DOING |
|Dance |
|Country | | | |
|Folk | | | |
|Square | | | |
|Aerobic | | | |
|Yoga | | | |
|Tap/Ballet/Jazz | | | |
|Rock n' Roll | | | |
|Line Dancing | | | |
|Other (please specify): | | | |
|Other (please specify): | | | |
|Arts and Crafts |
|Painting/Drawing | | | |
|Knitting | | | |
|Sewing | | | |
|Crocheting | | | |
|Latch Hook | | | |
|Embroidery | | | |
|Weaving | | | |
|Ceramics/Pottery | | | |
|Woodworking | | | |
|Jewelry Making | | | |
|Baking/Cooking | | | |
|Photography | | | |
|Other (please specify): | | | |
|Other (please specify): | | | |
|Table Games |
|Cards | | | |
|Checkers | | | |
|Chess | | | |
|Dominoes | | | |
|Scrabble | | | |
|Puzzle | | | |
|Billiards | | | |
|Bingo | | | |
|Board Game (please specify): | | | |
|Other (please specify): | | | |
|Other (please specify): | | | |
|Outdoor Leisure/Social |
|Hiking/Climbing | | | |
|Walking | | | |
|Gardening | | | |
|Camping | | | |
|Barbecues/Picnics | | | |
|Skiing/Sledding | | | |
|ACTIVITY |HAVE DONE |CURRENTLY DO |INTERESTED |
| |IN PAST | |IN DOING |
|Outdoor Leisure/Social (continued) |
|Canoeing | | | |
|Fishing | | | |
|Roller Skating/Roller Blading | | | |
|Ice Skating | | | |
|Bicycling | | | |
|Swimming | | | |
|Boating | | | |
|Lawn Games | | | |
|Beach | | | |
|Nature Study | | | |
|Weather Observation | | | |
|Bird Watching | | | |
|Amusement Parks/Fairs | | | |
|Other (please specify): | | | |
|Other (please specify): | | | |
|Community Activities/Entertainment |
|Historical | | | |
|Sporting Events | | | |
|Shopping | | | |
|Dining Out | | | |
|Library | | | |
|Aquarium | | | |
|Museums | | | |
|Concerts | | | |
|Hometown Events | | | |
|Recreation/Community Center | | | |
|Flea Markets | | | |
|Sightseeing | | | |
|Parades | | | |
|Video Games | | | |
|Collecting (stamps, rocks, etc.) | | | |
|Religious Services | | | |
|Auto Racing | | | |
|Boxing/Wrestling | | | |
|Spectator Sports (please specify): | | | |
|Movies | | | |
|Television | | | |
|Visit/Entertain Friends/Family | | | |
|Other (please specify): | | | |
|Other (please specify): | | | |
|Social Clubs/Organizations |
|Cultural Ethnic | | | |
|Cooking | | | |
|Card Playing | | | |
|Senior Citizens | | | |
|Religious | | | |
|Other (please specify): | | | |
|ACTIVITY |HAVE DONE |CURRENTLY DO |INTERESTED |
| |IN PAST | |IN DOING |
|Literacy/Continuing Education |
|Reading (books, magazines, etc.) | | | |
|Computers | | | |
|Letter Writing | | | |
|Adult Education Classes | | | |
|Computer Education | | | |
|Other (please specify): | | | |
|Other (please specify): | | | |
|Volunteer Work |
|Political Campaign | | | |
|Homeless Shelter | | | |
|Food Co-Op/Food Bank/SHARE | | | |
|Special Olympics | | | |
|Nursing Homes | | | |
|Recycling | | | |
|Other (please specify): | | | |
|Other (please specify): | | | |
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|NOTES |
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