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* 1. Are you a resident of Mount Shasta?

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* 2. Are you older then 18 years of Age?

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* 3. How many adults live in your household?

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* 4. How many adults in your household walk regularly

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* 5. How many adults in your household bicycle regularly?

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* 6. For each adult, how far is it from home to work (select all that apply)?

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* 7. How many children in your household?

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* 8. Please list each child's age

  0-4 5-9 10-14 15-18
child 1
child 2
child 3
child 4
child 5
child 6
child 7

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* 9. How many children in your household walk regularly?

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* 10. How many children in your household bicycle regularly? 

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* 11. How many children bicycle to school regularly

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* 12. If you have children in school, how many miles is it from home to school? (Please circle a distance for each child)

  0-1/2 mile 1/2-1 mile 1 -2 miles 2-5 miles More than 5 miles
Child 1
Child 2
Child 3
Child 4
Child 5
Child 6
Child 7

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* 13. In your opinion, how much do your children's schools encourage or discourage walking and biking to/from school? (Please select one).

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* 14. On most days how does your child arrive at school and return home from school? (Please mark the appropriate columns)

  Arrive at school Leave for home
Walk
Bicycle
School Bus
Own Family Vehicle
Carpool (other vehicle)

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* 15. To what extent do the following aspects affect your choice to allow your child to bicycle or walk more often?

  No effect A little Some Very Much Extremely affects
Convenience/comfort of car
Lack of bikeways
Lack of sidewalks
Afraid of cars/drivers
Destination too far(takes too long)
Difficult intersections
Bad weather
Lack of bicycle parking
Lack of shower
Personal security

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* 16. If the obstacles identified were removed would you be more likely to allow your child to bike or walk?

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* 17. For the period from May through September how often do you walk for each of the following purposes?

  Never Rarely (1-2 times per year) Sometimes (1-2 times per month) Very Often (1-2 times per week) Usually (Almost Daily)
Social/fitness/fun
Commute to work
School
Church/civil
Shopping

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* 18. To what extent do the following aspects affect your choice to walk more often?

  No effect A little Some Very Much Extremely effects
Convenience/comfort of car
Lack of bike ways
Lack of sidewalks
Afraid of cars/drivers
Destination too far (Takes too long)
Difficult intersections
Bad Weather
Lack of bicycle parking
Lack of shower
Personal security

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* 19. If the obstacles were removed would you be more likely to walk?

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* 20. How many adults in your household bicycle to work regularly?  (once a week or more)

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* 21. For the period form May through September how often do your bicycle for each of the following purposes (chose 1 per row)?

  Never Rarely (1-2 times per year) Sometimes(1-2 times per month) Very Often (1-2 times per week) Usually (almost daily)
Social/fitness/fun
Commute to work
School
Church/civil
Shopping

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* 22. To what extent do the following aspects affect your choice to bicycle more often?

  No effect A little Some Very much Extremely affects
Convenience/comfort of car
Lack of Bike ways
Lack of sidewalks
Afraid of cars/drivers
Destination too far (Takes too long)
Difficult intersections
Bad Weather
Lack of bicycle parking
Lack of shower
Personal security

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* 23. If the obstacles were removed would you be more likely to bicycle?

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* 24. From your experience list the  3 worst intersections, stretches of road, or other obstacles that need improvement. Identify each as either walking or riding obstacles.
(enter NONE if you have no comment)

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* 25. Please tell us about any unrealized opportunities, dreams, or down-to-earth projects that would improve the walking and bicycling experience in or around Mount Shasta (Enter NONE if you have no comment)

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* 26. Make additional comments here  (enter NONE if you have no additional comments)

0 of 26 answered
 

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