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Hello! Our 7th grade science class is conducting a survey on childhood diseases. Would you please take a few minutes to answer the following questions? We would greatly appreciate your participation. Thank you so very much.
Survey must be completed by:
March 4th, 2012

I Will Participate. (Please check box)

What is your age?

Do you live in Washington State?

Yes

No

If no, what state?

Have you had this disease?

Yes

No

Don't Know

What do you think caused this disease? (bacteria, virus, other organism or don’t know)

Are you familiar with its symptoms?

Yes

No

Don't Know

If so, what are the symptoms?

How is this disease transmitted? (through air, food, water, direct contact)

How old were you and how long did the disease last?