COVID-19 Industry Child Care Survey
This CHILD CARE survey is dedicated to those whose work may be continuing in the industrial setting in the midst of the COVID-19 situation. We are asking questions to plan for the child care support that may be needed in the coming weeks.

Please complete the survey completely to give us the best idea of how to prepare.
 
1.
I am employed at:?
 

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2.

Age of Child(ren) as of March 23, 2020 

0-12 Months
1-2 Years
2-3 Years
3-5 Years
5-12 Years- Elementary School
13+ Years- Middle & High School
3.
How many child(ren) in each age bracket above and total?   (ie: 1- 1-2 year old and 2- 5-12 year olds; 3 total)
 

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4.
I need child care to start at:
4:00 AM
4:30 AM
5:00 AM
5:30 AM
6:00 AM
6:30 AM
7:00 AM
7:30 AM
8:00 AM
Other  
5.
I need child care to end at:
4:00 PM
4:30 PM
5:00 PM
5:30 PM
6:00 PM
6:30 PM
7:00 PM
Other  
6.

Days of the Week, I need child care: 

Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
7.

My child care would need to be in: 

Brownstown
Crothersville
Medora
Seymour
I'm willing to drive within the county for child care in this emergency.
At my employer
Other  
8.

Do you have dependable child care currently? 

Yes
No
9.

My child(ren) have special needs, here are my concerns or what we would need addressed: 

 

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10.

Other Concerns: 

 

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11.

Enter your email: 

 

50 characters left.