Students:  Please complete the following questions and email this form by clicking on the submit button at the bottom of the form.  Or you may print out the evaluation form and mail it to: PO Box 174, Abilene, TX 79604-0174

Please answer Always, Sometime or Never to the following questions:

1. Since your visit to Safety City have you:

            Worn a seatbelt each time you rode in a car?   

          Worn a helmet each time you rode a bicycle, roller blades, skateboards, scooters?                          

        Helped / reminded your parents to replace the batteries in your smoke detector?                         

        Planned a fire escape route for you home?  

        Decided on a “safe meeting place” with your family?  

        Obeyed pedestrian safety laws?  

        Obeyed bicycle safety laws?  

2. Since your visit to Safety City have you worn a seatbelt?  

3. What was the best part of the fire safety house?   

4. Name two things you learned in the fire safety house.  

5. What was the best part of the traffic safety portion of the program?  

6. Name two things you learned with the traffic safety portion of the program.  

7. Please provide any additional comments about your visit to Safety City here:  

Optional: 

Name  

School