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Smart Bellies Survey / Encuesta de Smart Bellies
Please fill out the questions below by September 30th / Por favor, complete las preguntas a continuación antes del 30 de septiembre
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* Indicates required question
Family name (optional)
Apellido (opcional)
Your answer
Address
*
Cual es tu dirección?
Your answer
Phone Number
*
Número de teléfono
Your answer
Email
*
Your answer
Number of children in your household?
*
Cuantos niños viven en tu casa?
Choose
0
1
2
3
4
5
6
7
8
Number of people in your household including children?
*
Cuantos personas viven en tu casa incluyendo ninos?
Choose
0
1
2
3
4
5
6
7
8
What school(s) does your child(ren) attend? (check all that apply)
*
A qué escuelas asisten sus hijos?
Silverthorne Elementary
Dillon Valley Elementary
Frisco Elementary
Breckenridge Elementary
Upper Blue Elementary
Summit Cove Elementary
Summit Middle School
Summit High School
Snowy Peaks
Other:
Required
Which one best describes your child(ren)’s ethnicity?
*
Cual describe el origen etnico de su hijo(s)/hija(s)?
African American
Asian American
Hispanic/Latino
Caucasian/White
American Indian
Prefer not to say
Other:
Required
I would like to continue receiving Smart Bellies bags on Fridays for the 2022/23 school year.
*
Me gustaría seguir recibiendo comida de Smart Bellies los viernes para el año escolar 2022/23.
Yes
No
Other:
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