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Our Survey
 Sign of the times �The pressures of growing up in modern society �Call it what you will, The fact is that studies have shown:

*One out of 10 children ages 12 and 13 uses alcohol at least once a month

*In a single year, 522 children under age 14 were arrested for driving while intoxicated, (113 of them were under 10 years old).

*70 percent of all teenagers drink alcohol.

*60 percent of all teen deaths in car accidents are alcohol-related.

So, we would like to get some feedback from you to see if these statistics are real. If you fill out this survey we will be sure to send you some free gifts!





Guest Information:

Name:
Address:
City:
Zip
Phone:
Email:



How old are you?
12
13
14
15
16
17
18
19
20
Type A Different Age Here:



Have you ever drinken an alcoholic beverage?
Yes
No



How old were you when you had your first drink?
13-15
16-18
18-20
Under 13
I've never had a drink!



Why do you drink?
Peer Pressure
I get Bored
It tastes good
I don't know
I don't drink!



When do you drink?
At Parties
At home
When I want to have a good time!
When I'm Depressed
umm...Didn't I say i don't drink?



Has drinking led you to try different drugs?
Yes
No
For the Last time, I DON'T DRINK!!!!



Did you take the information on this site into consideration?
Yes
No









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