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If a child day care service was available in your town that offers home pick-up and drop-off services, would you use these services for your children? 
 
Yes
 
Maybe
 
No
 
 
What are the ages of your child/children that you would need these services for? (Mark all that apply)
 
Child (age 0 thru 2)
 
Child (age 3 thru 5)
 
Child (age 6 thru 9)
 
Child (age 10 thru 12)

 
 
What is your relationship to these children? 
 
Single parent
 
Married parent
 
Grandparent
 
Other_______________________________________
 
 
Which of the following are important to you when selecting child care arrangements?
(Mark all that apply) 
 
Cost is affordable
 
Licensed by the state
 
Other _________________________________________________________

 
 
How would you most likely use child day care pick-up and drop-off services? 
 
On a regularly scheduled- pre-arranged basis
 
As needed basis
 
 
What days of the week would you use child day care pick-up and/or drop-off services? (Mark all that apply) 
 
Monday
 
Tuesday
 
Wednesday
 
Thursday
 
Friday

 
 
Which time (or times) would you probably use child day care pick-up and drop-off services? (Mark all that apply)  
 
Mornings (6:00 am to 12:00 noon)
 
Afternoons (12:00 noon to 3:00 pm)
 
Evenings (3:00 pm to 9:00 pm)

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