TAKE PART IN RESEARCH™
Basis – Kids Research
Please amend any details that may have changed since last registering for research (current members only)
Daytime Contact Telephone Number
Alternative Contact Telephone Number
What is your current living status?
What is your employment status?
What is your ethnic group?
Mixed / Multiple ethnic group
Asian / Asian British
Black / African / Caribbean / Black British
Other ethnic group
Which age bracket do you fit into?
71 and over
What is your exact age?
Do you have Children?
Yes, I have 1 child living at home
Yes, I have 2 children living at home
Yes, I have 3+ children living at home
Yes, I have 4+ children living at home
Yes, but they don’t live at home anymore
Which of the following school years is your child / are your children in?
Not started school yet
No longer at school
What is the age and gender of your child in Year 4?
What is the age and gender of your child in Year 5?
What is the age and gender of your child in Year 6?
What is the age and gender of your child in Year 7?
What type of school do your children attend? [if your children attend different types of schools then tick all that apply]
Public / State School
State Boarding School
Home Schooled Only
Are you employed full time or part time?
Employed full time (30+ hours per week)
Employed part time (fewer than 30 hours per week)
Defence and Marine
Food and Drink
Pharmaceuticals and Biotechnology
Research & Design
Sports and Recreation
Are you the chief income earner in the household?
Occupation of the Chief income earner:
Your Contact Details
Which region do you live in?
East of England
Yorkshire and the Humber
Which Borough of London do in live in?
City of London
City of Westminster
Kensington and Chelsea
Hammersmith and Fulham
Richmond upon Thames
Kingston upon Thames
Barking and Dagenham
None of above
1st Line of Address & Postcode
We like to have a mixture of people who have and haven't done research, if you have I am just curious to see what topics you've done?
IF YES: What topics have you done and when were they?
Do you know anyone in your immediate family who works in any of these industries?
Media / Advertising
A telecommunications company
None of the above
What electrical devices do you have in your household?
Mobile Phone (non-Smart phone)
Tablet (e.g. iPad)
E-reader (e.g. Kindle)
None of the above
ADMIN: Are these internet enabled? If no, which ones are? must have at least 2 internet enabled devices (in addition to parents' smartphones)
Do you have a high speed broadband / internet connection at home?
On a scale of 1-10 (1=not at all tech savvy and 10=extremely tech savvy) where would you put your digital literacy? [WHERE 1 = NOT AT ALL TECH SAVVY AND 10 = EXTREMELY TECH SAVVY]
[WHERE 1 = NOT AT ALL TECH SAVVY AND 10 = EXTREMELY TECH SAVVY]
At the interview, the interviewer may ask if they can leave a small camera with you for you to film a short piece to camera, after you get back from a family shopping trip (they will explain more if they select you for this). You'd receive an extra £10 for doing this and Ia pre-paid envelope to send back the camera. Would you be happy to do this stage if needed? [ALL NEED TO SAY YES]
Who will be attending the in-home interview with the child?
Are you happy for your child to take part in a 5 day online community? This will involve discussing topics that will be mentioned in the in-home interview. The child will also be asked to post photos, videos, drawings and links all relevant to the activities and tasks on that day. All questions will be explained in detail and we’ll give examples where relevant.
ASK PARENT: Are you happy for you and members of your family to be filmed during the in home interview ? The footage will only be used for research purposes and will be kept internal. Any external footage will be edited and we may wish to use it for our website www.basisresearch.co.uk for the promotion of Basis Research and on any presentations.