* 1. The well being of our children and families is extremely valuable. Peninsula Health Care District is planning to start a series of free wellness education classes for parents and caregivers of the elementary and middle school children in northern San Mateo County. Topics will include health, nutrition, physical activity and general wellness. Here is a quick survey to determine how we can make this as accessible to you as possible.

How interested are you in attending free wellness education classes?

* 2. Please select in order of importance (1-4), which topics you would like to learn about regarding children’s health

  1 2 3 4
General wellness (stress reduction, time management, sleep)
Children’s physical fitness (active play, yoga, rainy day activities)
Nutrition (healthy snacks, healthier fast food, quick and easy meals, Rethink your Drink)
Social (friendship, stress, bullying)

* 3. Where would you be most likely to attend a wellness education class?

* 4. What is the most convenient time to hold wellness education classes?

* 5. Please indicate if childcare would be necessary if you were to attend a class at the following times? (Select all that apply)

* 6. Would you be more likely to attend if free childcare was provided?

* 7. What is the primary language spoken in your home?

* 8. What is the name of the school your child attends?

* 9. In what district is your child's school located?

* 10. Please add any additional comments or ideas of how we can better help serve you and your family through wellness education. Thank you for your time!