Parent Questionnaire 2010-2011 Survey

Name (optional)

What CLUB does your child attend?

Other (please specify school or club site)

What grade is your child in?

What grade is your child in? 1st

2nd

3rd

4th

5th

6th

7th

8th

9th

10th

11th

12th

1. As a result of attending the after school program my child’s grades have improved.

1. As a result of attending the after school program my child’s grades have improved. a) no

b) not sure

c) yes

2. As a result of attending the after school program my child’s school participation has improved.

2. As a result of attending the after school program my child’s school participation has improved. a) no

b) not sure

c) yes

3. How much does your child read books or magazines in their free time?

3. How much does your child read books or magazines in their free time? a) No time at all

b) Less than 1 hour

c) 1 to 2 hours

d) 2-3 hours

e) More than 3 hours

4. Approximately how many days per year does your child miss school?

4. Approximately how many days per year does your child miss school? a) 0-1 days per year

b) 2-4 days per year

c) 5-9 days per year

d) More than 10 days per year

5. My child is enthusiastic about going to school each day.

5. My child is enthusiastic about going to school each day. a) no

b) not sure

c) yes

6. My child is motivated to do his/her best in school.

6. My child is motivated to do his/her best in school. a) no

b) not sure

c) yes

7. I feel that my child is safe in the after school program.

7. I feel that my child is safe in the after school program. a) no

b) not sure

c) yes

8. The after school program enables me to work or go to school.

8. The after school program enables me to work or go to school. a) no	b) not sure	c) yes
Other (please specify)

9. My child is a good listener.

9. My child is a good listener. a) no

b) not sure

c) yes

10. As a result of the after school program, my child is more confident.

10. As a result of the after school program, my child is more confident. a) no

b) not sure

c) yes

11. My child understands the importance of community service at school or in the neighborhood.

11. My child understands the importance of community service at school or in the neighborhood. a) no

b) not sure

c) yes

12. As a result of the after school program, my child has helped with a community service project this year.

12. As a result of the after school program, my child has helped with a community service project this year. a) no

b) not sure

c) yes

13. My child wants to graduate from high school.

13. My child wants to graduate from high school. a) no

b) not sure

c) yes

14. My child plans to go to college.

14. My child plans to go to college. a) no

b) not sure

c) yes

15. The after school program helps my child set goals for the future.

15. The after school program helps my child set goals for the future. a) no

b) not sure

c) yes

16. I feel like the after school program staff are good role models.

16. I feel like the after school program staff are good role models. a) no

b) not sure

c) yes

17. My child likes coming to the after school program.

17. My child likes coming to the after school program. a) no

b) not sure

c) yes

18. As a result of my child attending the after school program I attend more school functions.

18. As a result of my child attending the after school program I attend more school functions. a) no

b) not sure

c) yes

19. How has the program helped your child’s school work?

20. How has the program helped your child’s behavior and interactions with others?

21. How has the program changed your child’s view of his/her future?

22. Please tell us how we can improve the after school program:

23. Would you like assistance obtaining health insurance?

23. Would you like assistance obtaining health insurance? a) no

b) not sure

c) yes

24. Would you or your child like help with: (please mark each one you need)

24. Would you or your child like help with: (please mark each one you need) Autism	Fitness	Obesity	Diabetes	Asthma	Smoking
Other (please specify)

Parent Questionnaire 2010-2011

Boys & Girls Clubs of Garden Grove Parent Survey

Name (optional)

What CLUB does your child attend?

What grade is your child in?

1. As a result of attending the after school program my child’s grades have improved.

2. As a result of attending the after school program my child’s school participation has improved.

3. How much does your child read books or magazines in their free time?

4. Approximately how many days per year does your child miss school?

5. My child is enthusiastic about going to school each day.

6. My child is motivated to do his/her best in school.

7. I feel that my child is safe in the after school program.

8. The after school program enables me to work or go to school.

9. My child is a good listener.

10. As a result of the after school program, my child is more confident.

11. My child understands the importance of community service at school or in the neighborhood.

12. As a result of the after school program, my child has helped with a community service project this year.

13. My child wants to graduate from high school.

14. My child plans to go to college.

15. The after school program helps my child set goals for the future.

16. I feel like the after school program staff are good role models.

17. My child likes coming to the after school program.

18. As a result of my child attending the after school program I attend more school functions.

19. How has the program helped your child’s school work?

20. How has the program helped your child’s behavior and interactions with others?

21. How has the program changed your child’s view of his/her future?

22. Please tell us how we can improve the after school program:

23. Would you like assistance obtaining health insurance?

24. Would you or your child like help with: (please mark each one you need)