Pool Alarm Community Needs Assessment

Safe Kids Treasure Coast along with the Florida Department of Health have a program which allows us to provide a limited amount of pool alarms to eligible families. Completing this survey does not guarantee that you will receive a pool alarm, but it will help us determine community need and plan distributions.

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* 1. Which county do you live in?

Saint Lucie

Martin

Okeechobee

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* 2. Do you have children living in the home?

Yes

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* 3. What are the ages of the children? Select all that apply.

0-3 years

4-6 years

7-10 years

11-14 years

15-18 years

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* 4. Do any of your children have autism?

Yes

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* 5. Which best describes your situation?

I have a swimming pool at my home

I do not have a pool but my child frequently visits a family member's pool

Neither of the above

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* 6. Would you be interested in receiving a pool alarm if eligible?

Yes

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* 7. Would you like to be contacted about this program?

Yes

Pool Alarm Community Needs Assessment

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* 1. Which county do you live in?

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* 2. Do you have children living in the home?

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* 3. What are the ages of the children? Select all that apply.

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* 4. Do any of your children have autism?

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* 5. Which best describes your situation?

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* 6. Would you be interested in receiving a pool alarm if eligible?

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* 7. Would you like to be contacted about this program?

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* 8. Please provide your name

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* 9. Please provide your phone number

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* 10. Please provide your email address