This survey is about swimming, academics, attendance, nutrition, physical activity, sports, sleep, and related information. It has been developed so you can tell us information about these topics so that we can better help meet the needs of you and your family through swimming and other support programs.
 
The answers you give will be kept private. No one will know what you write. Answer the questions based on what you really do.

Completing the survey is a required part of the registration process. 
 
The questions that ask about your background will be used only to describe the types of participants completing this survey. The information will not be used to find out or be linked to your name. No names will ever be reported.

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* 1. Please enter your first and last name. (Enter name of the swimmer if you are a parent assisting the swimmer in taking this survey)

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* 2. What school do you now attend?

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* 3. What grade are you in school? (If taking this survey in December, what grade will you be in next year?)

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* 4. How well do you speak English?

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* 5. During the past 12 months, how would you describe your grades in school?

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* 6. How tall are you without your shoes? In row one enter the number of feet and in row two enter the number of inches.

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* 7. How much do you weigh without your shoes on? Weight is measured in pounds and enter only whole numbers.

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* 8. My family interest is/was in the ______________________ program.

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* 9. Why did your family decide to join the City Swim Project?

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* 10. For each swimmer, please indicate their age range. Only complete for the number of swimmers participating in the program (if you have 5 swimmers complete all rows for Swimmers 1-5).

  Age Range
Swimmer 1
Swimmer 2
Swimmer 3
Swimmer 4
Swimmer 5
Swimmer 6
Swimmer 7
Swimmer 8
Swimmer 9
Swimmer 10

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* 11. Please specify your family's primary ethnicity.

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* 12. How would you describe your household?

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* 13. City of residence

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* 14. Enter your Zip Code of residence.

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* 15. How would you describe the education level of the adults (18+ years old) living in your household?

  Education Level
Adult 1
Adult 2
Adult 3
Adult 4
Adult 5
Adult 6
Adult 7
Adult 8
Adult 9
Adult 10

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* 16. Do any adults (18+ years old) in your household know how to swim?

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* 17. How many adults (aged 18+) learned how to swim since joining the City Swim Project?

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* 18. How would you describe your access to transportation?

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* 19. Has your income group changed in the last year?

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* 20. If yes, what is your new income group?

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* 21. What financial assistance was provided to your family?

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* 22. How often does your family speak English at home? (Click only one answer)

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* 23. What language do you speak at home? Only answer if English is not your primary language spoken at home.

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* 24. How often, before this program, did you go swimming?

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* 25. What barriers do you face to swimming? (please check all that apply)

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* 26. How did you hear about the City Swim Project?

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* 27. The website was easy to use, and the information was easy to understand.

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* 28. The registration or renewal process was easy.

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* 29. I was supported by City Swim Project staff during the registration or renewal process.

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* 30. Communication from the City Swim Project was understandable.

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* 31. Communication from the City Swim Project was timely.

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* 32. If strongly agree or disagree, please explain why?

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* 33. How often each week would you be willing to attend swim lessons?

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* 34. Would you attend a weekend session if made available?

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* 35. If yes, what time would be best for you between 9 am and 3 pm?

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* 36. During the past 7 days, on how many days were you physically active for a total of at least 60 minutes per day? (Add up all the time you spent in any kind of physical activity that increased your heart rate and made you breathe hard some of the time.)

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* 37. During the past 7 days, on how many days did you do exercises to strengthen or tone your muscles, such as push-ups, sit-ups, or weightlifting? (Add up all the time you spent in any kind of physical activity that increased your heart rate and made you breathe hard some of the time.)

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* 38. On an average school day, how many hours do you watch TV?

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* 39. On an average school day, how many hours do you play video or computer games or use a computer for something that is not schoolwork? (Count time spent playing games, watching videos, texting, or using social media on your smartphone, computer, Xbox, PlayStation, iPad or other tablet).

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* 40. During the past 12 months, on how many sports teams did you play? (Count any teams run by your school or community groups.)

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* 41. If you played on a team or teams, what sports did you play in the past 12 months? (please check all that apply)

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* 42. Which recreation options are you MORE LIKELY to do in the future now that you have been in the City Swim Project swimming program? (Please check any boxes that apply)

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* 43. Which water sports are you MORE LIKELY to try in the future now that you have been in the City Swim Project swimming program? (Please check any boxes that apply)

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* 44. When in school, how many days do you go to physical education (PE) classes? (Please check all that apply)

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* 45. During the past 12 months, how many times did you have a concussion from playing a sport or being physically active?

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* 46. How do you describe your weight?

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* 47. Which of the following are you trying to do about your weight?

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* 48. During the past 7 days, how many days did you eat breakfast?

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* 49. During the past 7 days, how often have you consumed the following? For each row select the answer from the drop down that best describes your habit.

  Times per week
Fruit (do not include any fruit juice/beverages)
100% fruit juice (do not include beverages such as punch or flavored drinks)
Vegetables (do not include French fries)
Water (include tap, bottled or unflavored sparkling)
Milk (count in a glass, cup from a carton or with cereal)
Soda or pop (any type, including diet)

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* 50. Do you know what GO, SLOW and WHOA type foods are?

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* 51. On an average school night, how many hours of sleep do you get?

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* 52. Do you have any physical, mental, or emotional problems diagnosed by a medical professional or therapist?

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* 53. Do you have difficulty concentrating, remembering, or making decisions?

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* 54. During the previous school year, approximately how many days of school did you miss?

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* 55. Which reasons were you absent from school, if any? (Please check all that apply)

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* 56. Do you expect to graduate from high school?

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* 57. Do you expect to further your education after high school? (For example, college, trade school, etc.).

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