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* 1. Name

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* 2. Tract/Lot

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* 3. Residency Information

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* 4. Do you have children ages 13 and under permanently residing in your home?

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* 5. Do you have grandchildren or extended family/friends with children under 13 who frequently visit BVS?

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* 6. How frequently do you utilize the playground at Cub Lake?

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* 7. How frequently do you utilize the playground at the Whiting Center?

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* 8. Ages of children permanently residing in your home (check all that apply)

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* 9. Name 3 components/equipment you would like to see included in the future playground design?

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* 10. If you could waive a magic wand and create a playground for BVS, what would it be or look like?

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* 11. Do you have a child, friend, or relative with special needs?

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* 12. Do you have any additional comments that have not been addressed in previous questions?

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