Glastonbury Nutrition Education – Elementary School Parent Survey

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* 1. My child(ren) attend(s) the following elementary school:

Buttonball Lane School

Eastbury School

Hebron Avenue School

Hopewell School

Naubuc School

Nayaug School

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* 2. Please indicate info about your child(ren) below – check all that apply if you have more than one child:

	Male	Female	Twins or Multiples
Infant to Pre-School (see below)	Infant to Pre-School (see below) Male	Infant to Pre-School (see below) Female	Infant to Pre-School (see below) Twins or Multiples
Kindergartener	Kindergartener Male	Kindergartener Female	Kindergartener Twins or Multiples
First Grader	First Grader Male	First Grader Female	First Grader Twins or Multiples
Second Grader	Second Grader Male	Second Grader Female	Second Grader Twins or Multiples
Third Grader	Third Grader Male	Third Grader Female	Third Grader Twins or Multiples
Fourth Grader	Fourth Grader Male	Fourth Grader Female	Fourth Grader Twins or Multiples
Fifth Grader	Fifth Grader Male	Fifth Grader Female	Fifth Grader Twins or Multiples
Gideon Welles	Gideon Welles Male	Gideon Welles Female	Gideon Welles Twins or Multiples
Smith Middle School	Smith Middle School Male	Smith Middle School Female	Smith Middle School Twins or Multiples
Glastonbury High School	Glastonbury High School Male	Glastonbury High School Female	Glastonbury High School Twins or Multiples
Other School	Other School Male	Other School Female	Other School Twins or Multiples

If you indicated Infant to Pre-school children please list ages here:

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* 3. Are there concerns about any food, dairy or nut allergies with your child(ren)?

Yes

Other (please specify)

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* 4. When buying prepared or packaged foods, does the food label impact your purchasing decision?

Always

Sometimes

Never

Comment

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* 5. Do you read both the Nutrition Facts and Ingredients List on food labels?

	Nutrition Facts	Ingredient List
Always	Always Nutrition Facts	Always Ingredient List
Sometimes	Sometimes Nutrition Facts	Sometimes Ingredient List
Never	Never Nutrition Facts	Never Ingredient List

Comment

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* 6. Do you follow label portion size guidelines?

Always

Sometimes

Never

Comment

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* 7. Are the children in your family involved with food purchasing decisions?

Always

Sometimes

Never

Comment

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* 8. If your child(ren) request specific types of food, where did he or she learn about it? (please check all that apply)

Requests foods were introduced at home

Tried it at a friends house

Saw an advertisement on television or online

Attracted to the package in the store

Tried it at lunchtime

Recommended by a friend

Mobile game app sponsored by food company

Other

Please specify what types of food they request

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* 9. Is getting your child(ren) to eat healthy foods, such as fresh fruits and vegetables, or balanced meals difficult? (please check all that apply)

	Always	Sometimes	Never
Younger Siblings	Younger Siblings Always	Younger Siblings Sometimes	Younger Siblings Never
Kindergartner	Kindergartner Always	Kindergartner Sometimes	Kindergartner Never
1st Grader	1st Grader Always	1st Grader Sometimes	1st Grader Never
2nd Grader	2nd Grader Always	2nd Grader Sometimes	2nd Grader Never
3rd Grader	3rd Grader Always	3rd Grader Sometimes	3rd Grader Never
4th Grader	4th Grader Always	4th Grader Sometimes	4th Grader Never
5th Grader	5th Grader Always	5th Grader Sometimes	5th Grader Never
Older Siblings	Older Siblings Always	Older Siblings Sometimes	Older Siblings Never

Comment

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* 10. What are some favorite snack foods in your family?

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* 11. What do you provide for a healthy snack? Please list below.

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* 12. What beverage does your child drink most often?

	At Mealtime	Between Meals
Plain Water	Plain Water At Mealtime	Plain Water Between Meals
Sparkling Water/Seltzer	Sparkling Water/Seltzer At Mealtime	Sparkling Water/Seltzer Between Meals
Fruit Juice	Fruit Juice At Mealtime	Fruit Juice Between Meals
Milk	Milk At Mealtime	Milk Between Meals
Sports Drinks	Sports Drinks At Mealtime	Sports Drinks Between Meals
Soda	Soda At Mealtime	Soda Between Meals
Energy Drinks	Energy Drinks At Mealtime	Energy Drinks Between Meals

Other (please specify)

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* 13. Are you or your pediatrician concerned about your child(ren)'s nutrition habits?

Occasionally

Yes

Comment

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* 14. Do you think that food should be offered as a reward for good behavior, or academic accomplishments at home or in the classroom?

	Always	Sometimes	Never
At Home	At Home Always	At Home Sometimes	At Home Never
In the Classroom	In the Classroom Always	In the Classroom Sometimes	In the Classroom Never

Comment

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* 15. Do you agree with alternative classroom party activities or celebrations where the focus is on the occasion and not food/beverage? For example, celebrate a special event with extended recess or a birthday with a special "birthday book" created by classmates.

Strongly Agree

Agree

Disagree

Strongly Disagree

Other

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* 16. Do you agree with candy being distributed to students in the classroom for occasions such as Halloween and Valentines day?

Strongly Agree

Agree

Disagree

Strongly Disagree

Comment

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* 17. How often does your family have the opportunity to eat dinner together?

Always

5-7 days a week

3-5 days a week

1-3 days a week

Never

Comment

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* 18. Please indicate which topic of nutrition you or your family would like to learn more about. Please check all that apply.

Nutrition Labels

Healthy Snack Guidelines

Healthy Recipes and Tips

Proper Portions

Menu Planning

USDA MyPlate Guidelines

Body Mass Index

Alternative Ways to Celebrate

Other (please specify)

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* 19. Have you read the Glastonbury Board of Education Wellness Policy 6142.1? If no, please skip the next question.

Yes

Unaware of Glastonbury's Wellness Policy

Other (please specify)

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* 20. Do you support the Glastonbury Wellness Policy, 6142.1?

Yes

Comment

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* 1. My child(ren) attend(s) the following elementary school:

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* 2. Please indicate info about your child(ren) below – check all that apply if you have more than one child:

Question Title

* 3. Are there concerns about any food, dairy or nut allergies with your child(ren)?

Question Title

* 4. When buying prepared or packaged foods, does the food label impact your purchasing decision?

Question Title

* 5. Do you read both the Nutrition Facts and Ingredients List on food labels?

Question Title

* 6. Do you follow label portion size guidelines?

Question Title

* 7. Are the children in your family involved with food purchasing decisions?

Question Title

* 8. If your child(ren) request specific types of food, where did he or she learn about it? (please check all that apply)

Question Title

* 9. Is getting your child(ren) to eat healthy foods, such as fresh fruits and vegetables, or balanced meals difficult? (please check all that apply)

Question Title

* 10. What are some favorite snack foods in your family?

Question Title

* 11. What do you provide for a healthy snack? Please list below.

Question Title

* 12. What beverage does your child drink most often?

Question Title

* 13. Are you or your pediatrician concerned about your child(ren)'s nutrition habits?

Question Title

* 14. Do you think that food should be offered as a reward for good behavior, or academic accomplishments at home or in the classroom?

Question Title

* 15. Do you agree with alternative classroom party activities or celebrations where the focus is on the occasion and not food/beverage? For example, celebrate a special event with extended recess or a birthday with a special "birthday book" created by classmates.

Question Title

* 16. Do you agree with candy being distributed to students in the classroom for occasions such as Halloween and Valentines day?

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* 17. How often does your family have the opportunity to eat dinner together?

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* 18. Please indicate which topic of nutrition you or your family would like to learn more about. Please check all that apply.

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* 19. Have you read the Glastonbury Board of Education Wellness Policy 6142.1? If no, please skip the next question.

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* 20. Do you support the Glastonbury Wellness Policy, 6142.1?

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* 21. Do you have any additional concerns or comments?