Thank you for filling out the 2016 LaneKids Parent Survey!

Raffle entries and survey responses are collected separately. Survey responses are confidential and anonymous. Only one entry per family.

Please provide your contact information below to be entered in a drawing for gift cards to:

Fred Meyer
Safeway
Target
Dutch Bros.
Off the Waffle

Passes to Splash! at Lively Park, The Science Factory, Bounce Gymnastics, & more!

Prize winners will be notified by June 15th, 2016.

Question Title

* 1. What is your first name?

Question Title

* 2. What is your last name?

Question Title

* 3. What is your street address?

Question Title

* 4. What is your phone number?

Question Title

* 5. What is your e-mail?

T