Three Rivers School Safe Routes to School Survey (For Parents)
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1. Three Rivers School

 
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1. School Name
2. What is the grade of the child who brought home this survey?
3. Is the child who brought home this survey male or female?
4. How many children do you have in Kindergarten through Eighth Grade?
5. What is the street intersection nearest your home? (provide the names of two intersecting streets)
6. How far does your child live from school? (choose one)
7. On most days, how does your child ARRIVE at school? (Choose One)
8. How long does it normally take for your child to get TO school?
9. On most days, how does your child LEAVE from school? (Choose One)
10. How long does it normally take for your child to get FROM school?
11. Has your child asked for permission to walk or bike to/from school in the last year?
12. At what grade would you allow your child to walk or bike without an adult to/from school?
13. Which of the following issues affected your decision to not allow your child to walk or bike to/from school? (Select all that apply)
14. Would you probably let your child walk or bike to/from school if these problems were changed or improved?
YesNoNot Sure
My child already walks or bikes to/from school
Distance
Convenience of driving
Time
Child's before or after-school activities
Speed of traffic along route
Amount of traffic along route
Adults to walk or bike with
Sidewalks or pathways
Safety of intersections and crossings
Crossing guards
Violence or crime
Weather or climate
15. In your opinion, how much does your child's school encourage or discourage walking and biking to/from school? (select one)
16. How much FUN is walking or biking to/from school for your child (select one)
17. How HEALTHY is walking or biking to/from school for your child? (select one)
18. What is the highest grade or year of school you completed? (select one)
19. Please provide any additional comments or suggestions concerning safer travel to school below.