KaBOOM! Playground Interest Questionnaire

Can you imagine collaborating with friends and neighbors to build your community a new place to play? Can you imagine a new playspace materializing in just one day? If so, a KaBOOM! playspace project may be the perfect opportunity for you! Thanks to the generosity of our many corporate partners, KaBOOM! has ongoing opportunities for community organizations to build a new playground. If interested in learning more please fill out this short questionnaire and a KaBOOM! representative will contact you. If you have any questions please contact needplayground@kaboom.org.

PLEASE NOTE: All fields below must be completed in order to submit your questionnaire.

Organization Name:  
Organization Mailing Address:  
Organization City:   Organization State:
     
Organization County:  
 
Organization Zip:   Organization Phone:  
 
Primary Contact First Name:   Primary Contact Last Name:  
Primary Contact Phone Number:
if different than organization phone
Title: E-mail Address:  
1.Describe your organization answering the following questions:
Does the organization have nonprofit status?    
If not, are you working on getting nonprofit status?   
Is the organization religiously affiliated?    
 
2.How many children are served at your site?
*Number of children served annually equals number of unique children that would use the new playground in a given year (estimations are acceptable).
Daily       Annually*      
 
3.Is your site open to the general public?    
 
4. Provide the following information about the children you serve:
Number of Children by Age Ethnicity %
Under 2
African American %
2-5 Hispanic %
6-12 Asian & Pacific Islander %
13 and Up Caucasian %
    Other %
 
5. Provide the following statistics (describe how you gathered this information):
The number of children at your site enrolled in federal free or reduced lunch programs.    
The average annual income of the families served by your organization.   
 
6. Is there a playground on site?  
When was it built?  
Will a new playground replace or augment your existing equipment? 
 
7. Do you own the land where you would like to build a playground?  
Landowner Name    Phone/Email   
 
8.Join our community! Register your KaBOOM! account

The KaBOOM! website has a variety of resources to help your playground dreams come true. Register now to take full advantage of our planning tools, on-demand trainings, Map of Play, mobile apps, and much more. Sign up today!

Please provide the following information so to help track the progress of your application:

KaBOOM! Web Registration User Name:    

Finally, please enter the letters and numbers you see below and click the "Submit Your Questionnaire" button.

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