We are collecting data from parents of children who are participating in the Play Hard, Don't Blink. sport eye safety program. We will use the information you provide to enhance our efforts and better understand the vision issues that are important to you. We appreciate your assistance in completing the form below. Please return to your league administrator when completed.

1. Has the use of the protective faceguard on the helmet prevented your child from being injured?

O Yes    O No

2. The use of the protective faceguard on the helmet is a good idea.

O Strongly Agree  O Agree  O Neutral  O Disagree  O Strongly Disagree

3. How satisfied are you with the protective eyewear offered by this baseball/softball league?

O Very Satisfied  O Satisfied  O Neutral  O Dissatisfied  O Very Dissatisfied

4. Does your child's baseball/softball league have a policy regarding the use of protective eyewear?

O Yes  O No  O Don't Know

5. As a parent, are you aware of the different types of protective eyewear that are available

O Yes  O No  O Don't Know

6. In the previous season, was your child injured in the face?

O Yes    O No

7. If so, did you take your child to any of the following?

O Emergency Room
O Physician (indicate type) ______________________________________________
O Other (indicate what) _________________________________________________

The Play Hard, Don't Blink. program is funded by the Ohio Department of Health, Bureau of Child and Family Health Services Save Our Sight Program.