Exit Body Kind Families Post Program Survey 2021 About you and your family Question Title * We hope you have enjoyed Body Kind Families. We would be grateful if you could please spend 10 minutes providing honest responses to this questionnaire. Parents who complete this survey will enter in the draw to win one of three, $100 vouchers. The details below will be used as your prize entry and then removed from the database so that your survey remains anonymous.All your responses on this survey are confidential and anonymous. This information will be used to create a report with collated information to the funding body, and be used internally within Butterfly to develop the program further. Selected statistics and quotes may be used on Butterfly social media to promote the program. None of your information will be identifiable. State/Province ZIP/Postal Code Email Address Phone Number Question Title * What is your age? 25-34 35-44 45-54 55-64 65+ Question Title * Which Gender do you identify with? Female Male Non-binary Other Question Title * What cultural background(s) do you most identify with? Question Title * Now, about your kids...Are you worried about any of your children (aged 12-18) having body image issues? Yes No Question Title * Are you worried about any of your children (12-18 years) having an eating disorder? Yes No Question Title * Are you worried about the weight of any children in your house (aged 12-18 years) Yes No Question Title * How many GIRLS aged 12-18 years do you have in your household? 0 1 2 3 4 5 More than 5 None Question Title * How many BOYS aged 12-18 years do you have in your household? 0 1 2 3 4 5 More than 5 Question Title * How many young people in your household, aged 12-18 years, identify as another gender? 0 1 2 3 4 5 More than 5 Question Title * What is the age of your oldest child (within the 12-18 years age bracket)? 12 13 14 15 16 17 18 Question Title * What is the age of your next oldest child (within the 12-18 year age bracket) I don't have another child 12 13 14 15 16 17 18 Question Title * What is the age of your next oldest child (within the 12-18 year age bracket) I don't have another child 12 13 14 15 16 17 18 Question Title * What is the age of your next oldest child (within the 12-18 year age bracket) I don't have another child 12 13 14 15 16 17 18 Question Title * What is the age of your next oldest child (within the 12-18 year age bracket) I don't have another child 12 13 14 15 16 17 18 17% of survey complete. Next