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Welcome to the Miami Township, OH, Action Line
Today is Tuesday, May 30, 2017.
Tobacco Free Environment Survey

Purpose. Please tell us what you think about tobacco-free recreational places for our community by answering the following questions.

* Information is required.

Contact Information

First Name:
Last Name:
ZIP:

* Tobacco use should be prohibited in the following places (tobacco is defined as any type of cigarette, e-cigarette, vapor pen, cigar or other tobacco related product):

(1) = Strongly Disagree
(5) = Strongly Agree

PARKS





 
* (1) = Strongly Disagree
(5) = Strongly Agree

PLAYGROUNDS





 
* (1) = Strongly Disagree
(5) = Strongly Agree

OUTDOOR SPORTS FACILITIES





 
* (1) = Strongly Disagree
(5) = Strongly Agree

SKATEBOARD / BIKE PARKS





 
* (1) = Strongly Disagree
(5) = Strongly Agree

HIKING / BIKING TRAILS





 
* (1) = Strongly Disagree
(5) = Strongly Agree

PICNIC GROUNDS





 
* How often do you, or someone from your family, visit a Miami Township park?



 
* How old are you?





 
* Are you a...(check all that apply)







8
 
* Are you a Miami Township resident?


 

* Information is required.

Notes:

If you send us a message, you will receive a Tracking Number allowing you to follow-up with your request, at your convenience.

Internal Use Only, Leave Blank:
Please leave this field blank and remove any values that have been populated for it.

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