Name of child / young person
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First Name
Last Name
Person completing Questionnaire
Relationship to the child / young person
Today's Date
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DD
YYYY
Child's Date of Birth
MM
DD
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1. Your child throws a ball in a controlled and accurate fashion.
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2. Your child catches a small ball (e.g., tennis ball size) thrown from a distance of 6 to 8 feet (1.8 to 2.4 meters).
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3. Your child hits an approaching ball or birdie with a bat or racquet accurately.
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4. Your child jumps easily over obstacles found in garden or play or sport environment.
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5. Your child runs as fast and in a similar way to other children of the same age and gender.
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6. If your child has a plan to do a motor activity, he/she can organise his / her body to follow the plan and effectively complete the task (e.g., building a cardboard or cushion "fort", moving on playground equipment, building a house or a structure with blocks or using craft materials).
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7. Your child's printing or writing or drawing in class is fast enough to keep up with the rest of the children in his class
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8. Your child’s printing or writing letters, numbers and words is legible, precise and accurate or, if your child is not yet printing, he or she colors and draws in a coordinated way and makes pictures that you can recognize.
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9. Your child uses appropriate effort or tension when printing or writing or drawing (no excessive pressure or tightness of grasp on the pencil, writing is not too heavy or dark, or too light).
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10. Your child cuts out pictures and shapes accurately and easily.
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11. Your child is interested in and likes participating in sports or active games requiring good motor skills.
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12. Your child learns new motor tasks (e.g., swimming, rollerblading) easily and does not require more practice or time than other children to achieve the same level of skill.
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13. Your child is quick and competent in tidying up, putting on shoes, tying shoes, dressing, etc.
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14. Your child would never be described as a “bull in a china shop” (that is, appears so clumsy that he or she might break fragile things in a small room).
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15. Your child does not fatigue easily or appear to slouch and “fall out” of the chair if required to sit for long periods.
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