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HAUPPAUGE STUDENT BREAKFAST SURVEY
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* Indicates required question
Email
*
Your email
Student Last Name
*
Your answer
Student First Name
*
Your answer
School
*
Bretton Woods
Pines
Forest Brook
Grade
*
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
Parent/Guardian Name
*
Your answer
1. Will your child need to have breakfast Served at school?
*
Yes
No
If you answered YES to the above question, please complete questions 2-4.
2. What time does your child arrive at school?
Time
:
AM
PM
3. Does your child come to school by bus?
Yes
No
Clear selection
4. Would you be willing to pay between $1.75 and $2.00 for a school breakfast?
Yes
No
Clear selection
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