Childcare survey
RequiredRequired Question(s)
Required 1.

Do you work full-time or part-time?

Full-time
Part-time
Other  
  • Comment:

  • 500 characters left.
Required 2.

Which shift do you usually work? 

1st Shift
2nd Shift
3rd Shift
  • Comment:

  • 500 characters left.
Required 3.

How many children in your home need childcare?

1
2
3
4
5
6 or more
  • Comment:

  • 500 characters left.
Required 4.
What are the ages of the children in your home?
0-12 months
12-24 months
24-36 months
3-5 years old
6-12 years old
  • Comment:

  • 500 characters left.
Required 5.
Do you need transportation to get your children to childcare?
Yes
No
  • Comment:

  • 500 characters left.
Required 6.

Do you receive childcare subsidy? 

Yes
No
Required 7.
When do you need childcare? Select all that apply.
Before school
After school
Snow days
2-hour delays
Sick childcare
Weekends
Other  
  • Comment:

  • 500 characters left.
Required 8.

Would you prefer home-based or center-based childcare 

Home-based
Center-based
  • Comment:

  • 500 characters left.
Required 9.

Would your family benefit from a centrally-located facility close to downtown Mansfield?

Yes
No
Other  
  • Comment:

  • 500 characters left.
10.
Please share with us any other childcare challenges that your family faces.
 

1000 characters left.
11.

May we contact you to follow up on this survey? If yes, please enter your contact information. If no, please leave blank.

 

1000 characters left.