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
YesNo
YesNo
Regulated, HomeRegulated, CentreUnregulated, RelativeUnregulated, NannyUnregulated, Baby-sitter (in her/his home)Other
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