Child Safety Survey

Thank you for participating in our child safety survey! Your response will help guide our current and future programs that support keeping the children in our community healthy and safe. If you enter your contact information in question 11 you will be entered to win a $25 Amazon gift card. Winners will be called after the survey closes.

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* 1. Have you heard of Safe Kids Larimer County?

Yes

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* 2. What is your zip code?

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* 3. How many children live with you?

Other (please specify)

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* 4. How old are the child(ren) that live with you? Please choose all that apply.

0-1

2-4

5-8

9-12

13-15

16-18

Other (please specify)

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* 5. Which of the following safety topics are you most confident in your knowledge of? Choose all that apply.

Gun Safety

Home Safety (household hazards, medication, furniture tip-overs)

Infant Safety (safe sleep, choking prevention)

Motor Vehicle Safety (Car seat, booster seat and/or teen driving)

Play Safety (playgrounds, sports)

Road Safety (bicycle, pedestrian, ATV)

Water Safety (pool, swimming, boating, activities close to open/swift water)

Other (please specify)

None of the above

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* 6. Please rank the following safety topics in order of importance to you and your family.

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* 7. Which of the following safety topics are you interested in learning more about? Choose all that apply.

Gun Safety

Home Safety (household hazards, medication, furniture tip-overs)

Infant Safety (safe sleep, choking prevention)

Motor Vehicle Safety (Car seat, booster seat and/or teen driving)

Play Safety (playgrounds, sports)

Road Safety (bicycle, pedestrian, ATV)

Water Safety (swimming, boating, activities close to open water)

Other (please specify)

None of the above

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* 8. Which of the following sources do you use when you want to know more about keeping your child(ren) safe? Check all that apply.

Social Media

Family Members

Friends

Pediatrician

Books/Magazines

Agency Websites (such as Healthy Children, Safe Kids, etc.)

Parenting Websites (such as Scary Mom, Parenting, etc.)

Parenting Blogs

Other (please specify)

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* 9. Would you be interested in a quarterly e-newsletter on child safety information?

Yes

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* 10. Is there any additional information, questions or concerns that you would like us to know about your interest in and commitment to preventing childhood injuries?

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* 11. Please enter your contact information if you would like to be entered into the drawing. Please note your information will only be used to contact you if you are one of the winners or answered 'yes' to a quarterly newsletter in question 9.

Name

Email Address

Phone Number