Siouxland CARES

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

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

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

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

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

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?

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* 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?

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

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

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

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* 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)

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

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

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)

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* 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)

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

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

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)

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* 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)

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)

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* 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)

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

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

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

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

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

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

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

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

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

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

Circle how you would describe your household:

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* 16. Circle how you would describe your household:

Circle how you would describe your income:

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* 17. Circle how you would describe your income:

What is your zip code?

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* 18. What is your zip code?

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

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

Are you?

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* 20. Are you?

School

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* 21. School

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