Beach Use and Safety Survey
Exit this survey

1. General Information

Some basic information so that I can compile the data into statistical format. Any personal information will be kept private.

1. Are you male or female?

Are you male or female? male

female

2. What year were you born?

What year were you born?

3. Please provide a few pieces of information about yourself

Please provide a few pieces of information about yourself Name:
City/Town:
State:
ZIP/Postal Code:
Country:
Email Address:
Phone Number:

4. What is your race? (check all that apply)

What is your race? (check all that apply) American Indian or Alaska Native

Asian

Black or African American

Native Hawaiian or Pacific Islander

White

Other

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