* 1. Answer the following as Yes, Definitely; Not Sure; or Definitely Not.

  Yes, Definitely Not Sure Definitely Not
School meals are healthy and my child wants to eat them.
Snacks and drinks that kids can purchase are healthy.
My child gets regular PE that he/she enjoys.
My child gets important information on being and staying healthy.
Playground/school grounds are safe.

* 2. Before and After School Programs:  If your child participates in a program after school or if you would consider sending your child to an afterschool program, please let us know how important these things are for after school time.

  Extremely Important Important Not Important
Healthy snacks
Health information
Physical activity
Help with school work
Social skills development

* 3. Opportunities for Families:  What programs for families would you be interested in attending?

  Would love to
come!
Maybe I
would come
Not for me
Learning about eating healthy
Learning about healthy cooking
Family Fun Night with active games
Health Fair with health screenings
Family dinner/night out
Family dance night

* 4. Helping with Health and Wellness:  Would you be willing to help us make the school healthier by….?

  I would love
to help
If I have
some time
Not right now
Volunteering at a healthy event at school
Calling other parents about events
Being a member of our county wellness committee
Being a member or your child's school's wellness committee
Talking to decision makers about the importance of
health

* 5. Getting Information:  What is the best way for us to tell you about changes we are making or events for families related to our
wellness efforts?

  Works best Maybe Not helpful
Posted on the website
Phone calls
E-mail
Newsletter
In person meetings (back to school
night/conferences)

* 6. What grade is your child in? (If you have more than one child, select all grades that apply.)

* 7. What school(s) does your child(ren) attend?

* 8. If you would like to be contacted to volunteer:

Report a problem

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