Park Perceptions Survey
RequiredRequired Question(s)
Required 1.

Where do you live?

Bellevue
Gretna
LaVista
Papillion
Springfield
Other  
Required 2.

Do you support a  smoke-free policy in your community parks?

No
Yes
Required 3.

Do you support a tobacco-free policy in your community parks?

No
Yes
Required 4.

Do you think tobacco litter is a problem in your community parks?

No
Yes
Required 5.

How often do you visit your community parks?

Daily
Weekly
Monthly
A few times a year
Yearly
I do not visit my community parks
Required 6.
What is your age?
 

50 characters left.
Required 7.

Are you a ___________?

Former tobacco user
Non-tobacco user
Tobacco user
Required 8.

What best describes you?

 

Check all that apply.

Grandparent
Parent
Park patron
Youth
Other  
Required 9.

Would you like to be added to Tobacco Free Sarpy's email list for quarterly updates?


No
Yes
10.

Please leave your email if you would like to be added to our quarerly newsletter mailing.

 

50 characters left.
11.

Please feel free to add any additional comments.

 

350 characters left.