2010-2011 PTA Activities Survey
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1. Default Section

	Very interested	Possible interest	No interest
Chess Club	*Please list your interest level for the following activities: Chess Club Very interested	Chess Club Possible interest	Chess Club No interest
Group Piano	Group Piano Very interested	Group Piano Possible interest	Group Piano No interest
FLES: Chinese	FLES: Chinese Very interested	FLES: Chinese Possible interest	FLES: Chinese No interest
FLES: Spanish	FLES: Spanish Very interested	FLES: Spanish Possible interest	FLES: Spanish No interest
FLES: French	FLES: French Very interested	FLES: French Possible interest	FLES: French No interest
Mad Science	Mad Science Very interested	Mad Science Possible interest	Mad Science No interest
Girls on the Run	Girls on the Run Very interested	Girls on the Run Possible interest	Girls on the Run No interest

If more than one child, please list no. of children and the activity ( ie: 3 kids for Chess Club)

	Very Important	Somewhat Important	Doesn't Matter Much	Deal Breaker	N/A
Transportation options (KAH bus in AM or activity bus in PM)	*If you are interested in one of these activities, is your likelihood to sign up based on the following: Transportation options (KAH bus in AM or activity bus in PM) Very Important	Transportation options (KAH bus in AM or activity bus in PM) Somewhat Important	Transportation options (KAH bus in AM or activity bus in PM) Doesn't Matter Much	Transportation options (KAH bus in AM or activity bus in PM) Deal Breaker	Transportation options (KAH bus in AM or activity bus in PM) N/A
Child's opinion	Child's opinion Very Important	Child's opinion Somewhat Important	Child's opinion Doesn't Matter Much	Child's opinion Deal Breaker	Child's opinion N/A
Cost of the program	Cost of the program Very Important	Cost of the program Somewhat Important	Cost of the program Doesn't Matter Much	Cost of the program Deal Breaker	Cost of the program N/A
Day of the week	Day of the week Very Important	Day of the week Somewhat Important	Day of the week Doesn't Matter Much	Day of the week Deal Breaker	Day of the week N/A
Time of the week (ie before or after school)	Time of the week (ie before or after school) Very Important	Time of the week (ie before or after school) Somewhat Important	Time of the week (ie before or after school) Doesn't Matter Much	Time of the week (ie before or after school) Deal Breaker	Time of the week (ie before or after school) N/A

Other (please specify)

If NO transportation option is available, will you: Set up your own carpool

Drive your child yourself

Will not sign up for the activity

Did not indicate a interest in any activities

Other (please specify)

Is there a current or new activity/program that you would be willing to coordinate/chair. If yes, please describe.

Parent's Name:

Parent's Email Address:

Children(s) name and incoming grade (Peter, 3rd grade):

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