Siouxland CARES

Your input is important as we continue to reduce underage drinking, drug use, and bullying in our community. Mark your response. 

* 1. Are you a parent/guardian of a child/children in (check all that apply):

* 2. Of the following, who do you feel has the greatest impact on your child/children's actions? (circle your first choice)

* 3. Do you feel it is okay for under-age children to consume alcohol at home in an unsupervised setting, as long as they stay at home?

* 4. How serious, in your opinion, is the problem of substance abuse among teens in Siouxland? (circle one number)

* 5. Is your information about illegal drugs, including new types of substances, sufficient to help you prevent underage usage by your child/children? (circle one)

* 6. Do you feel comfortable discussing the importance of not using alcohol and other drugs with your child? (circle one)

* 7. Have you and your child/children discussed the consequences of underage alcohol and other drug use, for example, legal problems or health problems? (circle your choice)

* 8. Do you feel you have the power to influence your child from abusing alcohol and drugs? (circle one)

* 9. Do you feel that you are prepared to answer difficult questions from your child/children such as, "Did you ever do drugs when you were younger?" (circle your choice)

* 10. Do you feel it is okay for under-age children to consume alcohol at home as long as a parent or other adult supervises it? (circle your choice)

* 11. Has your child/grandchild ever had any negative consequences from drinking alcohol, i.e. legal/school/missing class/medical? (circle one)

* 12. Do you feel your child is prepared to deal with bullying situations, personal or witnessed? (circle your choice)

* 13. Do you feel you are prepared to deal with bullying situations, personal or witnessed? (circle your choice)

* 14. Do you feel you would intervene in a bullying situation? (circle your choice)

* 15. Are you aware there is a bullying complaint and investigation process that you can use? (circle your choice)

* 16. Circle how you would describe your household:

* 17. Circle how you would describe your income:

* 18. What is your zip code?

* 19. Which race/ethnicity best describes you? (choose one)

* 20. Are you?

* 21. School

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