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Parent/Guardian Sign-Up Form
: Video Conversation with Students who Commute to School in Active Ways
If your student gets to
or from school by walking, biking, bus, train, carpooling, scootering, rollerblading, skateboard,
wheelchair, or other interesting way, we would love to hear from you and your student! Video interviews will be 20-25 minutes long and on Zoom.
If you have more than one student, please fill out only one form for just one of them.
We ask the following questions to ensure we have representation of all backgrounds and ages. All information will be kept confidential.
For more information about this project, go to
https://www.gogreenstreets.org/what-moves-everett-schools-information
Thank you! We will be in touch soon.
- "What Moves Everett Schools" Interview Team
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* Indicates required question
What is your name?
*
Your answer
What is the name of the student who will be participating in the conversation?
*
Your answer
What grade is your student in?
*
K
1
2
3
4
5
What school does your student attend?
*
Your answer
What is your student's gender?
Male
Female
Non-Binary
Other:
What is your student's race? (You may select more than one)
*
White
Black
Native American or Alaskan Native
Native Hawaiian or other Pacific Islander
Asian
Other:
Required
Is your student Hispanic or Latino?
*
Yes
No
In what ways does your student get to school?
*
Walk
Bike
Train
Bus or Van
Scooter
Rollerblades
Wheelchair
Skateboard
Carpool (riding in a car with others who live outside of your household)
Driven by an adult (no carpooling)
Other:
Required
If different from above, in what ways does your student leave school?
Walk
Bike
Train
Bus or Van
Scooter
Rollerblades
Wheelchair
Skateboard
Carpool (riding in a car with others who live outside of your household)
Driven by an adult (no carpooling)
Other:
Do you have other students who would like to participate? If so, what are their names and grades?
Your answer
What is your email address and/or phone number?
*
Your answer
We ask that a parent/guardians of each participant fill out a media release form before participating. Is this OK?
*
Yes
No
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