Spring Break Survey
Name
First Name
Last Name
Age
Gender
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Are you planning to travel during spring break?
Yes
No
What is the mode of transportation you're planning to use?
Airplane
Bus
Car
Train
What country are you planning to go?
What state are you planning to go to?
What is your primary reason for traveling?
Please explain and describe your plans during this travel.
What are the activities you're planning to do?
Play sports
Caving
Going to the beach
Hiking
Horseback riding
Mountain Biking
Canoeing
Snowboarding
Other
Do you know that you must quarantine yourself for 14 days before returning?
Yes
No
Are you aware that there places that are on the hot list due to COVID-19 pandemic?
Yes
No
Can you identify all the symptoms of COVID-19?
Yes
No
Do you need that you need extra precaution and always wear necessary protective equipment during your travel?
Yes
No
Comments, suggestions, or feedback
Submit
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