Lucastrong Choking Game Survey Please consider taking the Choking Game survey below. Your responses will help us gather information so that we can help others who may be playing this dangerous activity. Your answers are completely anonymous (no one will know who you are) unless you email us for counseling assistance. All the questions MUST have a response before submitting your survey. 1. How old are you now? 9 years old or younger 10 years old 11 years old 12 years old 13 years old 14 years old 15 years old or older 2. Are you male or female? Male Female 3. Have you heard of the “choking game”, “blackout” or any similar “game by any other name? Yes No 4. How old were you when you first heard about it? 6-8 yrs. old 9-11 yrs. old 12-13 yrs. old 14 years or older 5. Have you ever tried the choking game or similar game? Yes No 6. If you played before, was there someone with you? Yes No Have not played 7. Do you still play it? Yes No Have never played 8. If you still play, how often do you play? Only tried it once Only occasionally / 2-3 times a year On a regular basis / 2 or more times a month Have never played 9. If you tried it, did you think there was any risk in doing it? Yes No Did not try 10. If you never tried it, has anyone ever tried to get you to do it? Yes No 11. If someone tried to get you to do it, who? A person my own age A person older than me, but not an adult An adult No one has tried to get me to do it 12. Do you know someone who has played the choking game? Yes No 13. If you know someone who has played the choking game, how often do they do it? Just once Only occasionally / 2-3 times a year On a regular basis / 2 or more times a month Not sure 14. Do you know of or heard of anyone who has died from the choking game? Yes No Remember - This survey is completely anonymous, however if you would like to speak to a counselor or other TRUSTED adult about the choking game, please email us at: lucastrong15@gmail with your name and contact information. Your information will be kept confidential.
Your answers are completely anonymous (no one will know who you are) unless you email us for counseling assistance.
All the questions MUST have a response before submitting your survey.
Remember - This survey is completely anonymous, however if you would like to speak to a counselor or other TRUSTED adult about the choking game, please email us at: lucastrong15@gmail with your name and contact information. Your information will be kept confidential.
