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Head Start Pre-Survey

How old is your child?
Do you have an understanding of your child's nutritional needs for their age?
Yes, has complete understanding
Uncertain, has some understanding but not completely
No, has no understanding
Are you aware of resources for nutrition available to your family?
Yes
Unsure
No
How often does your child eat fast food?
More than 3 times a week
1-3 times a week
1-3 times a month
Less than once a month
Never
Do you think your child has an understanding of healthy and non-healthy foods?
Very likely
Likely
Neither likely nor unlikely
Unlikely
Very unlikely
Does your child get any physical activity at home?
A great deal
A lot
A moderate amount
A little
None at all
How high of a priority is it to get your child to eat healthy?
The most important priority
A top priority, but not the most important
Somewhat of a priority
Not very important
Not important at all
Do you have an understanding of your child's physical needs for their age?
Yes, has complete understanding
Uncertain, has some understanding but not completely
No, has no understanding
How close is your nearest park?
Walkable distance from home
Couple miles from home (less than 10 minutes by car)
Several miles from home (takes more than 15 minutes by car)
None available near me
Is there anything you would like to tell us or would like for us to know?
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