Boonville Middle School

SHAQ Survey Consent Form

February 2, 2026

Dear Parent or Guardian:

Boonville Middle School is preparing to measure physical activity and nutrition behaviors using a web-based survey. Students in grades 6-8  will participate in the Student Health Assessment Questionnaire (SHAQ). The purpose of this surveillance is to assess the need to improve our nutrition and physical activity practices and to better understand if our efforts are improving the health of students. Questions on the survey assess students’ physical activity and eating behaviors. Teachers will administer the questionnaire on during MRP on Feb 25, 2026

Mrs. Whyte & Mrs Slepsky the School Wellness Coordinators will supervise all measurement processes and will ensure your child’s privacy is respected at all times. Your child’s questionnaire data will remain strictly anonymous.

You can view the survey on our website:

Click here to View the Survey

Please indicate below if you would like your child to opt out of the survey:

No, my child may not participate in the survey.

Child’s First & Last Name: _________________________________________

Child’s Homeroom Teacher and Grade:_______________________________

Additional questions and the opt out form can be sent to Carolyn Whyte, cwhyte@warrick.k12.in.us 

Sincerely,

Jeanette Lindauer 

BMS Principal, jlindauer@warrick.k12.in.

Carolyn Whyte

BMS Wellness Coordinator