Siouxland CARES

Your input is important as we continue to reduce underage drinking, drug use, and bullying in our community. Mark your response. 

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* 1. Are you a parent/guardian of a child/children in (check all that apply):

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* 2. What is the name of the school that your child attends?

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* 3. Are you?

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* 4. Which race/ethnicity best describes you? (Check all that apply)

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* 5. What is your zip code?

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* 6. How would you describe your household (Check all that apply):

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* 7. How would you describe your household income:

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* 8. Of the following, who do you feel has the greatest impact on your child/children's actions? (circle your first choice)

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* 9. Do you feel it is okay for under-age children to consume alcohol at home in an unsupervised setting, as long as they stay at home?

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* 10. How serious, in your opinion, is the problem of substance abuse among teens in Siouxland? (circle one number)

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* 11. Is your information about illegal drugs, including new types of substances, sufficient to help you prevent underage usage by your child/children? (circle one)

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* 12. Do you feel comfortable discussing the importance of not using alcohol and other drugs with your child? (circle one)

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* 13. Have you and your child/children discussed the consequences of underage alcohol and other drug use, for example, legal problems or health problems? (circle your choice)

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* 14. Do you feel you have the power to influence your child from abusing alcohol and drugs? (circle one)

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* 15. Do you feel that you are prepared to answer difficult questions from your child/children such as, "Did you ever do drugs when you were younger?" (circle your choice)

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* 16. Do you feel it is okay for under-age children to consume alcohol at home as long as a parent or other adult supervises it? (circle your choice)

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* 17. Has your child ever had any negative consequences from drinking alcohol, i.e. legal/school/missing class/medical? (circle one)

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* 18. Do you feel your child is prepared to deal with bullying situations, personal or witnessed? (circle your choice)

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* 19. Do you feel you are prepared to deal with bullying situations, personal or witnessed? (circle your choice)

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* 20. Do you feel you would intervene in a bullying situation? (circle your choice)

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* 21. Are you aware there is a bullying complaint and investigation process that you can use? (circle your choice)

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