Enrollment Survey

We are so excited that you have registered your child to be a part of this amazing program to build a library in your home to encourage reading! Being literate is so important for the future success of your child, and by enrolling in this program we know that you know this is true!

The goal of this program is to support a love of reading through books and family togetherness. Please take a few minutes to answer the following questions, which we will ask you at the end of the program too. All answers are anonymous and help us understand if this program really does make a difference, and if this program should continue in the future.

Sign in to Google to save your progress. Learn more
Childʻs Zip Code *
Childʻs Gender *
Native Hawaiian? *
Language used most often in your home *
Childʻs Age *
Do you currently have a home library of books that are age appropriate for your child?
1-5 books
6-10 books
10-20 books
30+ books
Choose one
Clear selection
How often do you visit your public library?
1-5 times per year
Not at this time
Choose One
Clear selection
When you read to your child, do you involve them (e.g. point to and/or talk about items in the book, ask questions related to the story, etc.)
Not sure
Not applicable
Choose One
Clear selection
How often do you read with your child? (Choose one) *
Does your child: *
Not sure
Not applicable
Show interest in books?
Listen attentively while being read to?
Interact with you while you read together?
Read or look at books on their own?
Hold or attempt to turn pages from front to back?
Please share any additional comments you may have
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy