Healthy Families Play Outside
Registration Form

Instructions

Groups that played outside on safari 2008 and 2009 can re-register here.

New participants can fill out the two part form below and return it to any Lincoln public library after December 15, 2009. The Lincoln Safari begins January 1 2010. Registration begins on December 15, 2009 with five winter spots.

STEP 1

* = Required Field

Group or Family Name: *

(Be Creative!)

Number of adults in group: *

(Enter #'s only)

Number of children in group:

(Enter #'s only)

Ages of adults:

(List ages in numbers only #-###)

Ages of children:

(If more than 5, just give us a sample of ages. Use #'s only)

Contact Person’s First Name: *

Contact Person’s Last Name: *

Street address: *

City: *

State: *

Zip: *

(Enter #'s only)

Telephone: *

(Enter #'s only)

Email:

Will you need public transportation: *

Yes    No

What Ethnicities Are Represented In Your Group *

African American
Asian
Caucasian not Hispanic 
Hispanic / Latino
Russian
Sudanese
Other

If Other - Please Specify:



In order to learn how well the program works, we are also asking you to complete the following brief survey and fill out a final survey at the end of the project. This group data will be not be used for marketing, but will be used to determine program effectiveness and may be shared at science and zoo-related conferences and in publications.

To evaluate this project we will be collecting data on:

The number of families and/or groups who register
The number of families and/or groups who visit the various Safari sites
The number of families and/or groups who attend one of the events sponsored by the partners

On average, how much time did you spend together out of doors during 2009? *

less than 1 hour per week
1 – 3 hours per week 
3 – 5 hours per week
5 – 7  hours per week
more than 7 hours per week

Approximately how many Lincoln city parks and outside recreation areas (e.g. Pioneer Park, Lincoln Children’s Zoo, Hyde Observatory, Star City Shores) did you visit in 2009? *

less than 5
between 5 and 15
between 16 and 23
between 24 and 35
over 35

How important is it for you to spend time together outdoors? *

5 - Very Important
4 - Important
3 - Neutral  
2 - Not at all Important
1 - Undecided

...