Banana Splits 2017 Pre-survey
Hello boys and girls!

The purpose of this survey is for me to understand how you feel about divorce or separation and your family. There are no right or wrong answers. Please just answer truthfully from your heart.
What is your first name
Your answer
What is your last name
Your answer
What grade are you in?
I believe children can cause their parents' divorce or separation
I could talk to the following people about how I am feeling: (check all that apply)
Your family is different than some of your friends whose biological mom and dad live in the same home. How does this make you feel?
I get teased because my family is different
When I have sad or other difficult feelings, I can: (check all that apply)
Spending time with and accepting step family members or a new person in my parents' life :
Since my parents have divorced or separated, I feel
When I think about my family I believe that
Check all of the boxes that you find really hard about having parents that don't live together
In the space provided below, tell me whatever you think I should know about you or your family that would help me support you in this group:
Your answer
The End :)
Thank you for taking this survey. We are going to have fun together in Banana Splits Club!
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