Dear Parent or Caregiver,

Your child's elementary school wants to learn your thoughts about children walking and biking to school. This survey will take about 5 minutes to complete. We ask that each family complete one survey. If you have more than one child in elementary school, fill out the survey for the child with the next birthday from today's date.
Your responses will be confidential.

Question Title

* 1. School Name:

Question Title

* 2. What is the grade of the child you are completing this survey for?

Question Title

* 3. What is the gender of your child?

Question Title

* 5. What are the two streets that intersect nearest your home? Provide the name of two intersecting streets.

Question Title

* 6. How far does your child live from school?

Question Title

* 7. On most days, how does your child arrive and leave for school? (select once choice per column)

  Arrive at School Leave From School
Walk
Bike
School Bus
Family Vehicle (only children in your family)
Carpool (Children from other families)
Transit (City bus, taxi, ect.)
Other (Skateboard, scooter, inline skates, other)

Question Title

* 8. How long does it normally take for your child to travel to school?

Question Title

* 9. How long does it normally take for your child to travel home from school?

Question Title

* 10. Has your child asked you for permission to walk or bike to/from school in the last year?

Question Title

* 11. Does your child Walk or Bike to/from School?

0 of 19 answered
 

T