First we would like to ask you about your experiences at this program. Please indicate the extent of your agreement with each of the following items.
11. How has this program made a difference for you or your family?
12. What changes (if any) would you recommend to this program?
Experience Survey
Please respond to the questions below.
In the future, what more could we be offering to help you as a parent/caregiver?
About You
For Questions 1-10, please respond for your own family only. If you do not have the information or would rather not answer a question, please skip that question.
1. How long have you been living in your current neighborhood or town?
2. What is your postal code? (no spaces)
3. How long have you lived in Canada?
4. How long have you been participating in programs offered by this centre?
5. What language do you use most often at home?
6. Where did you learn about this program? (Select all that apply)
7. What is the total before tax income of all members of your household?
Under $19,999 per year |
$60,000 to $79,999 per year |
$20,000 to $39,999 per year |
$80,000 to $99,999 per year |
$40,000 to $59,999 per year |
Over $100,000 per year |
8. What is the highest level of education you have completed?
9. Please provide the following information about you and any other adult family members who have participated in this program during the last month.
10. Please provide the following information on your children who have participated in this program during the last month. If you did not bring any of your own children to the program, please go direct to Question 11.
11. Please provide the following information on the children you brought to the program as a caregiver. If you did not bring any children to the program as a caregiver, please go to Question 12.
12. Please share any other comments or suggestions.
This field is meant for spam prevention - please safely ignore.