Heather on Horseback

Answer Sheet

As you read the problem booklet, mark your answers in the boxes below.
Circle a T or F in front of each answer number. Please don't write in
the problem booklet.

  ---------------- ---------------- ---------------- ---------------- ----------------
  [Question        [Question        [Question        [Question        [Question
  A]{.underline}   B]{.underline}   C]{.underline}   D]{.underline}   E]{.underline}

  T F 1.           T F 7.           T F 13.          T F 18.          T F 22.

  T F 2.           T F 8.           T F 14.          T F 19.          T F 23.

  T F 3.           T F 9.           T F 15.          T F 20.          T F 24.

  T F 4.           T F 10.          T F 16.          T F 21.          T F 25.

  T F 5.           T F 11.          T F 17.                           T F 26.

  T F 6.           T F 12.                                            T F 27.

                                                                      T F 28.

                                                                      T F 29.

                                                                      T F 30.
  ---------------- ---------------- ---------------- ---------------- ----------------

Please complete the questionnaire on the bottom and back of this page.
Thanks!

**Questionnaire**

(Please complete this questionnaire [after]{.underline} the class
discussion of the exercise. Answer all the relevant questions. Consider
as a child any person who is less than 16 years old.)

1\) Name of exercise [Heather on Horseback]{.underline} 2) Your age
\_\_\_\_\_\_\_\_ 3) Your sex \_\_\_\_ M \_\_\_\_ F

4\) Years of horseback riding \_\_\_\_ 5) Do you train horses? \_\_\_\_
Yes \_\_\_\_ No

6\) For every 10 times you ride, how many times do you wear a helmet?

(Circle one number) 0 1 2 3 4 5 6 7 8 9 10

7\) Have you ever fallen or been thrown from a horse? \_\_\_\_ Yes
\_\_\_\_ No

8\) If "yes" to item #7, were you injured? \_\_\_\_ Yes \_\_\_\_ No

9\) If "yes" to item #8, were you wearing a helmet? \_\_\_\_ Yes
\_\_\_\_ No

10\) Have you ever ***nearly*** been thrown or fallen while horseback
riding? \_\_\_\_ Yes \_\_\_\_ No

11\) If "yes" to item #10 were you wearing a helmet? \_\_\_\_ Yes
\_\_\_\_ No

12\) Have you ever received a head injury while riding a horse? \_\_\_\_
Yes \_\_\_\_ No

13\) If "yes" to item #12, were you wearing a helmet? \_\_\_\_ Yes
\_\_\_\_ No

Think about the exercise you just finished. Circle the number, which
tells how much you agree or disagree with the following statements.

Strongly Strongly

[Disagree Agree]{.underline}

14\) The situation described in this exercise could happen to me. 1 2 3
4

15\) I learned nothing new from this exercise. 1 2 3 4

16\) This exercise helped convince me that wearing a helmet 1 2 3 4

while horseback riding can prevent head injuries.

17\) When riding horses children should be supervised. 1 2 3 4

18\) This exercise will help me to remember the risks of riding without
a helmet. 1 2 3 4

19\) This exercise was too long 1 2 3 4

20\) I liked doing this exercise. 1 2 3 4

21\) The written directions in the exercise were easy to understand. 1 2
3 4

22\) The exercise drawings were easy to understand. 1 2 3 4

24\) The exercise story was easy to read. 1 2 3 4

25\) I had chance to discuss the exercise story and my ideas. 1 2 3 4