Child Care Partnerships

Workshops, Support Groups, and Playgroups Survey  

Instructions:  Please fill out the following survey, letting us know whether you would be interested in attending   any workshops, support groups and/or play groups.  Also, let us know what topics are of interest to you.  If you don’t see a topic listed below, add it to the list.  We want to provide the best services possible.  In order to achieve   this, we want your input!  Thanks!

 PART A

Would you be interested in attending workshops in your area?   _____YES     ______NO

 If YES, please answer the following questions:

 1.  What times are best for you to attend a workshop?

 _______Weekday morning    _______Weekday afternoon       _______Weekday evening             

 _____Weekend morning    ____Weekend afternoon       _____Weekend evening

 2.  What is an ideal length of time for a workshop?

 ______ one hour       _____ two hours          _____three hours           _____four hours

 3.  How many children do you have in the following age groups?

 _______infants (newborn to 18 mos)   _______toddlers (18 mos to 3 yrs)   ______kindergarten (5-6 yrs)

 _______elementary (6-12 yrs)               _______preschool (3-4 yrs)              ______teenagers (13-18 yrs)

Please check the workshop topics below that are of interest to you:

 Children’s topics:

 __________Secure environments                  __________Positive Parenting 101

 __________Child Development                    __________Talking with your child about sex/alcohol/other drugs

 __________Others__________________________________________________________________________

  Self-growth topics:

 ___________Problem-solving skills                               ___________Stress management

 ___________Communication skills                               ___________Taking care of the caregiver

 ___________Other__________________________________________________________________________

 4.  Would you be willing to participate in a panel presentation on any topic for a workshop? _________________

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PART B 

Would you be interested in attending ongoing support groups in your area?

______YES       _____NO

If YES, please answer the following questions:

 1.  What times are best for you to attend an ongoing support group?

_______ Weekday afternoon              _______Weekday evening

_______ Weekend afternoon              _______ Weekend evening

2.  What is an ideal length of time for an ongoing support group?

       _____one hour       _____one and a half hours      _____two hours

3.  If you were to attend an ongoing support group, would you need child care?

       ______YES       ______NO

Please check the support groups that are of interest to you:

Support Groups:

___________Children with Special Needs         ___________Teen pregnancy

___________Grandparents/guardians                ___________Single parents

___________Grief and Loss                                  ___________Other: ___________________________________

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Part C

1.  Would you be interested in bringing your child to a playgroup? ________________________

 2.  What time would be best for you and your child to attend an ongoing playgroup?

 ______________Weekday morning             ______________Weekday afternoon

 ______________Weekend morning             ______________Weekend afternoon

Contact Information (Optional)

May we contact you to let you know of upcoming workshops, support groups, and/or playgroups?__________

Name: _____________________________________________

Phone: ___________________________________________

Address: ____________________________________________________________________

E-mail address: ______________________________________________________________ 

Thank you for taking the time to give us your input!