Leisure Interest Survey

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
IN PAST / CURRENTLY DO / INTERESTED
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
IN PAST / CURRENTLY DO / INTERESTED
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
IN PAST / CURRENTLY DO / INTERESTED
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
IN PAST / CURRENTLY DO / INTERESTED
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):
NOTES