COVID-19 - Parent Feedback Survey

Hybrid Learning

Please fill out one survey per child.

Question Title

* 1. Depending on the climate of COVID-19 in our community, EBRP Head Start students will return to school on January 5, 2021. With safety measures in place, how likely are you to send your child back to school in a Hybrid setting? (ex. 2-3 days per week)

Likely

Unlikely

Undecided

Question Title

* 2. If you selected undecided or unlikely to the previous question, would you like for your child to continue Virtual learning?

No

Yes

Question Title

* 3. Have you observed any physical, emotional, or behavioral changes in your child?

Yes

No

Question Title

* 4. Has anyone in your household been diagnosed with or exposed to COVID-19?

Yes

No

Question Title

* 5. Please enter your contact information below

Name

Child's name

Head Start Center

Email Address

Phone Number