Your child's school wants to learn your thoughts about children walking and biking to school. This survey will take about 5 - 10 minutes to complete. We ask that each family complete only one survey per school your children attend. If more than one child from a school brings a survey home, please fill out the survey for the child with the next birthday from today's date.

Your responses will be kept confidential and neither your name nor your child's name will be associated with any results.

* 1. What is the street intersection nearest to your house? (optional)

* 2. Gender

* 4. Grade

* 5. Does this school have a Safe Routes to Schools Program?

* 6. What is the approximate distance from your home to the school?

* 7. Has this child asked your permission to walk or bike to/from school in the last year?

* 8. Last week, how did this child travel TO school? Please check one box per day.

  Walk Bicycle Family Car (your kids only) School bus  Carpool (with other kids) City bus/transit Other (scooter, skateboard, etc.)
Monday
Tuesday
Wednesday
Thursday
Friday

* 9. Last week, how did this child travel FROM school? Please check one box per day.

  Walk Bicycle Family Car (your kids only) School bus  Carpool (with other kids) City bus/transit Other (scooter, skateboard, etc.)
Monday
Tuesday
Wednesday
Thursday
Friday

* 10. In general, was this a typical week of travel for this child?

* 11. Do you have a second child who attends elementary, middle, or high school in Alameda County?

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