Safe Routes Peekskill Survey
DIRECTIONS: Please complete a form response for EACH child who attends school in the Peekskill CSD.
Sign in to Google to save your progress. Learn more
Email *
1. Which PCSD school does your child attend? *
Required
2. How does your child get to school in the morning? *
Required
3. Why is your child driven or why does your child drive to school?
4. If you drive your child to school or if your child drives themselves to school, please identify streets, intersections, or locations that are problematic or dangerous.  
5. Please identify the reason(s) for the problem/danger (e.g. traffic, overgrown bushes, construction, missing or poorly located crosswalks, deteriorated sidewalks, lack of crossing guards, lack of enforcement, lack of snow removal)?
6. If your child walks to school, please identify any problematic streets, intersections or locations that make it difficult or unpleasant to walk to school.
7. Please also identify the specific problems  (e.g. traffic, overgrown bushes, construction, missing or poorly located crosswalks, deteriorated/broken sidewalks, lack of crossing guards, lack of traffic enforcement, lack of snow removal)?
8. Who helps ensure your child arrives safely to school? (Please check all that apply.) *
Required
9. If you drive your child to school, do you drive your child to the school entrance or as close as the school allows?  [If “No” skip to Question #13]
10. If yes, would you consider dropping your child off a block from the school?
11. If no, why not?
12. If maybe, what conditions would encourage you to do so?
13. Would you drop your child off a block or two blocks from the school, if there was a designated place and a responsible adult to walk your child to school?
14. If maybe, what conditions would encourage you to do so?
15. Would you be interested in taking part in a neighborhood walk to school program led by a trusted parent in your neighborhood?
16. If no, why not?
17. If maybe, what conditions would encourage you to do so?
18. Would you be interested in setting up a car pool with neighbors who are also driving children to school?
19. If no, why not?
20. If maybe, what conditions would encourage you to do so?
21. How does your child get home from school in the afternoon? *
Required
22. If your child is picked up or driven by car in the afternoon, why is this the case?
23. Do you or your child have any additional or different concerns to report regarding routes home from school? *
Required
24. If yes, please identify any problematic streets, intersections or locations that make it unsafe, difficult or unpleasant to walk home from school.
25. If yes, please identify the specific problems (e.g. traffic, overgrown bushes, construction, missing or poorly located crosswalks, deteriorated/broken sidewalks, lack of crossing guards, lack of traffic enforcement, lack of snow removal)?
26. Have you reported concerns about safety getting to/from school?   *
Required
27. If yes, when and to whom did you report this information?  What was the result?
28. If no, why not? *
Required
29. We are gathering a coalition of parents, students and Peekskill residents to address these issues with our city, county and state governments.  Are you interested in participating or receiving information? *
Required
30. If yes, please provide the following information in the space below: Name, Email, Phone, and Primary Language.
WHOM TO CALL TO REPORT PROBLEMS
If there is excessive garbage in an area, please call the City of Peekskill at 914-734-4130.  If there is an issue with overgrown bushes that are obstructing the sidewalk, or damaged sidewalks, please call the City of Peekskill at 914-734-4130.  In the winter, if there is an unshoveled sidewalk, please call the City of Peekskill at 914-734-4130.  Before contacting city services, please note the name of the streets, intersection, or number of the house where the problem exists.
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Google Forms