Greater Baltimore Children and Nature Membership Survey
1.
Your Name
 

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2.
If applicable, your organization (or agency, company, school, etc.)
 

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3.
Please enter the information indicated below.
Work Phone:
Email Address:
emailaddress@xyz.com
Address 1:
Address 2:
City:
State/Province
(US/Canada):
Postal Code:

4.
If you would like to be a member, but you are not the main contact person for your organization, please provide additional name and information for main contact.
 

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5.
What is your interest in the collaborative?
We provide programs/experiences that connect children/families w/ nature
Seeking info about programs/places that connect children/families w/ nature
We would like to support the current effort
6.
May we list you on the website as a member of the Greater Baltimore Children and Nature Collaborative?
Yes, as an individual (name only)
Yes, please list my name and organization
Yes, please list my organization only
No, I wish to be a member and receive information, but do list me on website
7.
If your organization provides programs, would you like to be listed in an online and/or hard copy directory of organizations that provide programs/places/experiences that connect children and/or families with nature?
Yes, please list our organization and main contact information
Our organization does not wish to be listed
8.
Would you like to receive the directory?
Yes
No
9.
Which of these categories best describes your organization? (check all that apply)
Environment
Conservation
Education - Outdoor, Environmental, Conservation, Nature-based
Education - Early, K-12
Education - College, University, Continuing Adult
Health
Government
Business
Faith Based
Parent/Family
Youth
Seniors
Recreation
Community
Service
Other 
10.
Of those you checked above, which category BEST describes your organization? (check one)
Environment
Conservation
Education - Environmental, Conservation, Outdoor, Nature-based
Education - Early, K-12
Education - College, University, Continuing Adult
Health
Government
Business
Faith Based
Parent/Family
Youth
Seniors
Recreation
Community
Service
Other 
11.
What are some examples of programs/activities that your organization conducts to connect children and/or families with nature?
 

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12.
Are there some things you are thinking of doing to connect children and/or families with nature? (Maybe others are on the same path.)
 

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13.
Does anything come to mind about connecting children with nature when you try to fill in the blanks here:

We could have _________________________________________ if only we had __________________________.
 

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