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* 1. Which county do you live in?

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* 2. Are you a...

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* 3. How old are you? (example - 11)

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* 4. Have you taken part in a TransOptions education program within the past year? (i.e. Ready to Walk & Roll, Traffic Safety Town, Bike Drivers Ed, Learn to Ride, Walk/Bike to School Days)

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* 5. How often do you use your bicycle (or skateboard, roller skates, scooter, etc.)?

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* 6. Where do you usually ride your bicycle (or skateboard, roller skates, scooter)? (Check all that apply)

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* 7. Do you wear a helmet when riding your bicycle (or skateboard, roller skates, scooter)?

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* 8. How often do you wear your helmet?

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* 9. Do your parents or guardians wear a helmet?

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* 10. While riding your bicycle around, how likely do you think it is that you could get hurt?

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* 11. If you fell or were in a crash, how helpful do you think a helmet would be at keeping you safe?

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* 13. What are the main reasons for you to NOT wear a helmet all the time? (Check all that apply)

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* 14. If you fell off your bicycle and you WERE NOT wearing a helmet, what is the worst thing that could happen to you?

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* 15. If you fell off your bicycle and you WERE wearing a helmet, what is the worst thing that could happen to you?

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* 16. If you were involved in a crash with a car while riding a bicycle and you WERE NOT wearing a helmet, what is the worst thing that could happen to you?

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* 17. If you were involved in a crash with a car while bicycle and you WERE wearing a helmet, what is the worst thing that could happen to you?

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* 18. What are your peers' attitudes toward you wearing a helmet?

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* 19. Do skilled bike riders need to wear a helmet?

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* 20. Can wearing a bike helmet help save your life?

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* 21. Is wearing a helmet a good way to protect your head from injury?

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* 22. How likely are you to start or continue to wear your helmet as you get older?

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* 23. Are you going to take your bike out for a ride today?!

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