GENERAL
Your gender: □ Male □ Female (*)
Age of your adolescent:
13* 14 15 16 17 18
PERSONALITY/SELF
Which of the following are closest in describing your teen:
Extrovert or Introvert? Introvert
Aggressive, Assertive or Submissive? Submissive
Predictable or Unpredictable? Predictable
Mature or Immature? Mature
Independent or Dependent? Independent
More Angelic or Devious? Angelic
What do you consider is your teen’s greatest strengths and weaknesses?
Compassion for strenth poor self image for weakness
What is your teen’s attitude towards his/her body? (please choose one)
□ Loves his/her body
□ Happy with his/her body
□ Wants changes to his/her body (*)
□ Hates his/her body
What are your teen’s fears?
LIFE
What is your teen currently putting most of his/her energy into? Martial Arts
What personal issues is your teen trying to resolve? Self image
Who has the most daily influence on your teen’s thoughts and behaviours? Parents, music influences
Who would your teen confide in if there was a serious issue? Parent
SOCIAL LIFE
What are the names of your teen’s 3 closest friends? Mikaela, Dylan, Jodie
Who does your teen consider to be his/her biggest enemy? Peer from school leave unnamed
Is or has your teen been involved in a relationship?
□ Yes(*) □ No
ENTERTAINMENT
What is your teen’s favourite hobby or pastime? Scrapbooking, martial arts
What is your teen’s favourite television shows? Mcleods daughters, channel V
ALCOHOL/DRUGS/SEX
How often does your teen consume alcoholic beverages?
□ Never (*) to my knowledge
□ Social Drinker
□ Often drinks
Has your teen ever smoked a cigarette?
□ Yes □ No(*)
Has your teen ever tried any illicit drugs like marijuana?
□ Yes □ No(*)
Has your teen been involved in sexual activity?
□ Yes □ No(*) To my knowledge
Has your teen ever watch an X-rated video/film?
□ Yes □ No(*) to my knowledge
Purchased contraceptives?
□ Yes □ No(*) again to my knowledge
EXPENDITURE
What does your teen spend most of his/her money on?
□ Food and snacks
□ Clothes
□ Entertainment/Movies
□ Other: __Mobile phone credit, jewellery_______________________________
EDUCATION
Does your teen still attend school?
□ Yes(*) □ No
How does or did your teen perform at school?
□ Very well(*)
□ Average
□ Poor
What does/did your teen want to do once he/she completes/completed school? Has vision of university, still only early teen yet
THANK YOU SO MUCH FOR YOUR CONTRIBUTION!