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* 1. What community do you work in?

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* 2. Which best describes your current employment? 
e.g. Education, Finance and Economics, Mining, Manufacturing.

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* 3. 1.     What is your current employment status?

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* 4. 1.     What best describes your work schedule?

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* 5. What age and number of children would you require childcare? Please indicate the number of children in each age group.

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* 6. Number of infant toddlers

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* 7. Number of 3-5 year olds

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* 8. Number of school age

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* 9. How likely are you to require childcare at the following times:

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* 10. 1.     In the next 12 months, on what basis would you most commonly require childcare? Please select all that apply.

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* 11. If given the choice, what type of childcare would you prefer? (select all that apply)

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* 12. What best describes your back-up childcare plan? (Eg. Childcare cancels, your child feels unwell but isn’t ‘sick’)

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* 13. What employment benefits do you feel childcare services would provide to you? Please select all that apply.

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* 14. What items are most important to you in a childcare service? Please select all that apply.

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* 15. Do you have a management position? If yes, move to #13.

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* 16. Would you be interested in attending a community round table regarding child care needs in Prince Rupert?

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* 17. If you responded YES to the above question, please provide your contact information below.

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* 18. Please let us know if you have any additional comments or concerns regarding childcare services.

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