Safe Routes to School Family Survey
Dear Parents or Caregivers,

Your child's school is curious to know what you think about kids walking and biking to school. It won't take long to fill out this survey, just about 5 to 10 minutes. Please make sure your family only does one survey for each school your children go to.

In order to make sure we get a random sample of ages in our responses, if more than one child in your family goes to the same school, please fill out the survey for the child with the next birthday from today.

For example, if today is 9/23 and you have three kids at the same school with birthdays on 2/17, 7/3, and 11/27, then use the information for the child with the birthday on 11/27.

If you get a survey from a different school (for instance, one of your kids is in middle school while the others are in elementary school, and both schools sent Family Surveys), you should fill out ANOTHER survey for that child at that school.

Don't worry, your answers will be private, and no one will know your name or your child's name when looking at the results.

This survey asks you questions about how your child gets to school. We want to know what makes you decide if your child walks or rides to school. We will use your answers to find out what things make it hard or easy for kids to walk or ride to school. Then we can work on making it easier for kids to walk or ride to school. Your answers will help us make your community better for walking and rolling. 

Thank you for taking the time to answer these questions.
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School Name *
If your school is not on the list (because you haven't signed up yet), no problem!  Click "Not On List" and then put your school name in the next question.
Is your school not on the list?
Please put your school's official name here (no abbreviations, please)
What is your child's grade? *
Reminder: Use the details from the child whose birthday is closest to today when filling out the form.
What is this child's gender? *
How many children do you have in kindergarten through 8th grade? *
What is the street intersection nearest your home?
Provide the names of 2 intersecting streets
*
How far does your child live from school? *
On most days, how does your child ARRIVE at school? *
This is for ARRIVAL only.  Departure from school is the next question.
On most days, how does your child LEAVE from school? *
How long does it normally take your child to travel TO school? *
How long does it normally take your child to travel FROM school? *
Has your child asked you for permission to walk or bike to/from school within the last year? *
At what grade would you allow your child to walk or bike to/from school without an adult? *

What things helped you decide if your child could (or could NOT) walk or bike to and from school? 
*
Required
Would you probably let your child walk or bike to/from school if the problems in the previous question were fixed? *
You need to put an answer for each row.
Yes
No
Not Sure
My child already walks/bikes to/from school
Distance
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 or intersections and crossings
Crossing guards
Violence or crime
Weather or climate
In your opinion, does your child's school encourage kids to walk or bike to and from school? *
Strongly Discourages
Strongly Encourages
How much fun is walking or biking to/from school for your child? *
Very Boring
Very Fun
How healthy is walking or biking to/from school for your child? *
Very Unhealthy
Very Healthy
What is the highest grade or school year you completed? *
This is question is for you, the adult filling out this form.
Please provide any additional comments *
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