Parent Satisfaction Survey

This survey will help us improve our services.

Zip code you reside in:

Ages of children in your household:

*Describe main care taker(s) in your household?
Single parentTwo parentsTeen parentGrandparentOther relative

*What concerns you most when looking for child care?
CostLocationQualityAvailability of hours/daysSize of group

*When working, what type of child care do you need?
Full day (more than 6 hours)Part day (less than 6 hours)Evening Overnight WeekendBefore & after schoolSummer only

Do you worry about your children while in care? Y/N (please explain)

*Who cares for your children when they are ill, school is closed, or it is a holiday?
Child care programSelf/ other parentRelative/friend outside of the home

Has anyone in your household/family had to take time off or quit a job because of child care problems? Y/N (Please explain)

*When paying for child care with your current employment, what is the maximum you can afford? (Based on full time weekly care)

Would you be interested in attending a workshop on any of the following topics? (Check all that apply)
Behavioral issuesHealth & SafetySocial emotional developmentParent/ provider relationsAge appropriate activitiesLanguage/ literacy issues

Please specify what days & times you may be available to attend a workshop on topics chosen above? (Please select day and time)

What type of workshop would work best for you?

Do you need the workshop in another language? (If yes, please specify what language)