Section I

1. Is your child currently attending a licensed child care centre?
Yes (skip to #3) No

2. Are you waiting for a space in a licensed child care program?
Yes No

3. Do the current hours of care offered meet... Please choose one All of your needs Most of your needs Some of your needs None of your needs

If your child is in licensed care and the hours of care offered meet all your needs please go to Section V

If the hours of care do not meet your needs - please continue to answer the following questions. The information provided will allow us to develop a plan that may assist in meeting your needs.

Section II

1. If you require child care outside the regular hours of 7 a.m. to 6 p.m., Monday to Friday, what would be your reason?

Work School Other

2. If your reason is for work, which sector is it in? This will give us an indication of what type of work requires extended care.

Section III

Please indicate the hours of care that you require on each specific day of the week. Insert the time and choose a.m. or p.m. (for example: you may require care from 2:45 p.m. to 12:30 a.m.)

Section IV

If the Children's Services Division could expand its hours of operation to satisfy your child care needs, how likely would you be to use this service?

Please choose one Definitely would Probably would Undecided Probably would not Definitely would not

Section V

1. In what geographic area of Peel would you require child care? (please check all that apply)

2. How many children under the age of 12 do you have that require child care?

Section VI

Do you want to receive information about this project? If yes, please complete the following:

Section VII

Please add any comments or suggestions that would help us as we develop this program.