Question Title

* 1. What school is your family affiliated with? Please check only one.

Question Title

* 2. Which classroom teacher is your family affiliated with? If your student is a Middle Schooler, please list the teacher who told your family about the Clean Water At Home Pledge.

Question Title

* 3. Which step(s) does your family pledge to take to help protect water quality in the Scituate Reservoir watershed, or whatever watershed you live in? Check at least one and as many as you wish. Please feel free to check items you are already doing and will continue to do!

Question Title

* 4. Before this communication from school, which Scituate Reservoir Watershed Education Program programs has your family encountered? Please check all that apply.

Question Title

* 5. May we contact you during June or July 2019 to find out how these changes have worked for your family with another short survey? If so, please enter the email address of an adult over 18 years old in this field. We will not add your email to our list or contact you for any other reason.

Question Title

* 6. We pledge that our family will complete the action(s) checked above to the best of our ability during the year 2019 (and hopefully beyond!) Please initial to agree.

Question Title

* 7. We pledge that our family has completed this survey only onceĀ per child. Please initial to agree.

T