Childcare for Voters Interest Form

Childcare for Voters Interest Form
Request for childcare

As we try to plan for the upcoming election we want to hear from YOU. Help us make sure parents can get to the polls! If you're be interested in updates about our work in your area, please be sure to provide your name and email address at the bottom of the form.
Where will you be voting?*

Street Address

Street Address Line 2

CityState

Zip Code
Do you anticipate needing childcare in order to vote in the upcoming election?*

YesNoMaybe
What is the reason you anticipate needing childcare?*

Expecting long wait time to voteMy child/ren's school will be closed on Election DayI have a squirmy kid and don't want to bring them to the polling stationScheduling issuesOther
Would you prefer to have a drop-in care site or use your own babysitter?*

Drop-in siteMy usual babysitterOther providerEitherOther
When do you usually try to vote?*

As soon as I can during early votingWhenever is convenient during early votingOn Election DayOther
Is there anything else you would like us to know?
How did you hear about Politisit?

Politisit WebsiteSocial MediaWord of Mouth/FriendFlyerOther
Name

First NameLast Name
Email
example@example.com
Should be Empty:

Request for childcare