Parent Survey

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School Name:

1. What grade is your child in? (K-8)

2. Is the child male or female: Male Female

3. How many children do you have in Kindergarten through 8th grade?

4. What is the street intersecion nearest your home? (provide the names of two intersecting streets)
and

5. How far does your child live from school?
less than 1/4 mile 1/4 mile up to 1/2 mile 1/2 mile up to 1 mile 1 mile up to 2 miles More than 2 miles Don't know

6. On most days, how does your child arrive at school?
Walk Bike School Bus Family vehicle (only with children from your family) Carpool (riding with children from other families) Transit (city bus, subway, etc.) Other (skateboard, scooter, inline skates, etc.)

On most days, how does your child leave for home after school?
Walk Bike School Bus Family vehicle (only with children from your family) Carpool (riding with children from other families) Transit (city bus, subway, etc.) Other (skateboard, scooter, inline skates, etc.)

7. How long does it normally take your child to get to school?
Less than 5 minutes 5-10 minutes 11-20 Minutes More than 20 minutes Don't Know/Not Sure

How long does it normally take your child to get home from school?
Less than 5 minutes 5-10 minutes 11-20 Minutes More than 20 minutes Don't Know/Not Sure

8. Has your child asked you for permission to walk or bike to/from school in the last year?
Yes No

9. At what grade would you allow your child to walk or bike without an adult to/from school?
(or I would not feel comfortable at any grade)

10. Which of the following issues affected your decision to allow, or not allow, your child to walk or bike to/from school?

	Would you probably let your child walk or bike to/from school if this problem were changed or improved?
Distance	Yes No Not Sure
Convenience of driving	Yes No Not Sure
Time	Yes No Not Sure
Child's before or after-school activities	Yes No Not Sure
Speed of traffic along route	Yes No Not Sure
Amount of traffic along route	Yes No Not Sure
Aduts to walk or bike with	Yes No Not Sure
Sidewalks or pathways	Yes No Not Sure
Safety of intersections and crossings	Yes No Not Sure
Crossing Guards	Yes No Not Sure
Violence or crimes	Yes No Not Sure
Weather or climate	Yes No Not Sure

11. In your opinion, how much does your child's school encourage or discourage walking and biking to/from school?
Strongly Encourage Encourage Neither Discourage Strongly Discourage

12. How much FUN is walking or biking to/from school for your child?
Very Fun Fun Neutral Boring Very Boring

13. How HEALTHY is walking or biking to/from school for your child?
Very Healthy Healthy Neautral Unhealthy Very Unhealthy

14. What is the highest grade or year of school you completed?
Grades 1 through 8 (elementary) Grades 9 through 11 (some high school Grade 12 or GED (high school graduate) College 1 to 3 years (some college or technical school) College 4 years or more (college graduate) Prefer not to answer

15. Please provide any additional comments: