Childcare Center Selection Survey Form
Please complete the Childcare Center Selection Survey Form to help us understand your family's needs and preferences.
Parent/Guardian Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Child's First Name
*
Child's Age Group
*
Please Select
Infant (0-12 months)
Toddler (1-3 years)
Preschool (3-5 years)
Pre-K/Kindergarten (5-6 years)
Other
Preferred Days of Care
*
Monday
Tuesday
Wednesday
Thursday
Friday
Preferred Start Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
What type of care are you seeking?
*
Full-time
Part-time
Drop-in
Other
How important are the following factors in your childcare center selection?
*
Rows
Not Important
Somewhat Important
Very Important
Location
1
2
3
Curriculum
4
5
6
Teacher Qualifications
7
8
9
Safety & Security
10
11
12
Cost
13
14
15
Hours of Operation
16
17
18
Overall, how would you rate your experience with our childcare center so far?
1
2
3
4
5
Please share any additional comments or information to help us understand your family's needs.
Submit
Should be Empty: