Three Rivers Childcare Co-op: Community Child Care Needs Survey
This survey helps assess whether there is a need for child care services in your community. Your participation will inform planning, but it does not commit you to use the service.
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Do you currently need child care services?
Yes
No
Do you currently have child care arrangements?
Yes
No
If yes, please indicate your current arrangements. Please select all that apply.
Unregulated
Relative
Nanny
Babysitter (in their home)
Regulated
Centre
Home
Other
If a regulated, community-owned child care service opened in your area, would you consider using it?
Yes
No
Please list children requiring care (infant to 12 years old)
Rows
Child's Name
Year of Birth
Child 1
Child 2
Child 3
Child 4
Child 5
Type of child care services required (please complete)
Rows
Number of Children
Hours of Care Required (e.g. 7:30 am to 5:30 pm)
Time Period (e.g. Sept to June)
Full Time
Part Time
Evening
Overnight
Weekend
School Age Care (Before & After)
Winter Break
Spring Break
Summer Break
School Inservice Days
Do any of your children have special needs (developmental, physical, medical)?
Yes
No
If yes, please describe (optional)
Do you, or your children, require additional supports (e.g. for vulnerable sectors, trauma-informed care, language supports)?
Yes
No
If yes, please describe (optional)
Do you identify as:
Indigenous
Newcomer to Canada
Neither
Prefer not to say
Would you be interested in helping with the development or operation of a co-operative child care centre?
Yes
No
Do you have any additional comments, ideas or suggestions?
Submit
Should be Empty: