Demographics (Standalone) - Play On Philly

Child's Name*

First Last

Child's Gender*

Your relation to child:*

e.g. Mother, Father, etc.

Number of adults in your household:*

An adult is anyone over the age of 18.

Number of children in your household:*

A child is anyone under the age of 18.

What is the highest level of education you've received?*

Does the child live with you?*

Child's household income level:*

How would you describe this child:*

Select all that apply.

Has your child been diagnosed with a disability?*

Please indicate the type of disability:*

Which is the primary language in child's home?*

Which is the primary language for this child?*

Play On Philly 2021-22 School Year