Community Child Care Services Survey

Survey of Need for Child Care Services

The purpose of this survey is to establish if there is a need to develop additional child care spaces in the Gull Lake area. Completing this survey does not obligate nor commit you to using the services developed. Please provide the following information:
Name

First NameLast Name
Telephone
Format: (000) 000-0000.
Address
1.Do you presently need child care services?

YesNo
2.Do you presently have child care arrangements?

YesNo
a. If yes, please indicate present arrangement

Regulated, HomeRegulated, CentreUnregulated, RelativeUnregulated, NannyUnregulated, Baby-sitter (in her/his home)Other
3.If a regulated child care service was opened in your area, would you use the service?

YesNo
Continue only if you answered Yes to Question 3.

4. Please list any children requiring child care between infant to 12 years of age.

5. Please indicate the type of service you would require:

Rows	Number of children	Hours of Care	Hours of care Term care is needed (i.e. September to June)
Full-time
Part-time
Occasional
Weekend
Evening
School-age-care
Other – please specify including number of children

6.Would you be interested in becoming involved in the development or operation of child care service?

YesNo
7.Do you have any comments or suggestions?
Thank you for your participation in our survey.
Should be Empty: