Parent Survey about Walking and Biking to School
Dear Parent or Caregiver,

Your child's school wants to learn your thoughts about children walking and biking to school. This online survey will take about 5 -10 minutes to complete. We ask that each family complete only one survey per school your children attend. If more than one child from a school brings a survey home, please fill out the survey for the child with the next birthday from today's date.

Your responses will be kept confidential and neither your name nor your child's name will be associated with any results.

Thank you for participating in this survey!

1. School Name *
2. What is the grade of the child who brought home this survey? *
3. Is the child who brought home this survey male or female? *
4. How many children do you have in Kindergarten through 8th grade? *
Your answer
5. What is the street intersection nearest your home? (Provide the name of two intersecting streets) *
Your answer
6. How far does your child live from school? *
7. On most days, how does your child arrive and leave for school? (Select one choice per column) *
School Bus
Family vehicle (only children in your family)
Carpool (children from other families)
Transit (city bus, subway, etc.)
Other (skateboard, scooter, inline skates, etc.)
Arrive at school
Leave from school
8. How long does it normally take your child to get to/from school? (Select one choice per column) *
Less than 5 minutes
5 - 10 minutes
11 - 20 minutes
More than 20 minutes
Don't know/ Not sure
Travel time to school
Travel time from school
9. Has your child asked you for permission to walk or bike to/from school in the last year? *
10. At what grade would you allow your child to walk or bike to/from school without an adult? (Select a grade between PK, K, 1, 2, 3...) *
11. What of the following issues affected your decision to allow, or not allow, your child to walk or bike to/from school? (Select ALL that apply) *
12. Would you probably let your child walk or bike to/from school if this problem were changed or improved? (Select one choice per line.) *
Not Sure
Convenience of driving
Child's before or after-school activities
Speed of traffic along route
Amount of traffic along route
Adults to walk or bike with
Sidewalks or pathways
Safety of intersections and crossings
Crossing guards
Violence or crime
Weather or climate
My child already walks or bikes to/from school
13. In your opinion, how much does your child's school encourage or discourage walking and biking to/from school? *
14. How much fun is walking and biking to/from school for your child? *
15. How healthy is walking or biking to/from school for your child? *
16. What is the highest grade or year of school you completed? *
17. Please provide any additional comments below.
Your answer
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