1: *Your Gender

2: *Your Age





3: *What is your Zip Code?
4: *How many children / grandchildren do you have?
5: *What are the ages of your children/grandchildren? Check all that apply.



6: *Do any of your children / grandchildren have special needs?

7: What is your average household income? (Optional)




8: *How much would you be willing to pay per visit(per child), for an indoor, all inclusive, children's recreational center? Parents are free.


9: *What is the furthest you would be willing to travel to an indoor, all inclusive, children's recreational center?



10: *How many times (per month) do you visit these places?
  0 1 - 2 3 - 4 5+
Chuck E. Cheese (Richland)
Slinky Action Zone (Altoona)
Discovery Center (Johnstown)
Local YMCA/YWCA

* = required