Rutland CAO 2021 Summer Passport   Parent Survey
Please fill out this form if you are the parent or guardian of a child who used a Summer Passport. Completing this survey enters your child in the grand prize drawing.  Please provide your email address and phone number  so that we can reach you if your child is selected as one of the winners.  Thank you!
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Your child's first name *
Email *
Phone number *
My child identifies as: *
What grade is your child in? *
Which school does your child go to? *
During the past 7 days, on how many days was your child physically active for a total of at least 60 minutes per day? *
On an average weekday, how many hours does your child watch TV, play video or computer games, or use a computer for something that is not school work? *
How did you hear about the Come Alive Passport Program? *
What is your annual household income from all sources? *
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