Boston Shambhala Center ~ Family and Children involvement in our community

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1. Getting to know you: Please tell us the age and gender of your children.

	1	2	3	4	5	6	7	8	9	10	11	12	13	14	15	16	17	18	19	20+
Boy(s):	*Getting to know you: Please tell us the age and gender of your children. Boy(s): 1	Boy(s): 2	Boy(s): 3	Boy(s): 4	Boy(s): 5	Boy(s): 6	Boy(s): 7	Boy(s): 8	Boy(s): 9	Boy(s): 10	Boy(s): 11	Boy(s): 12	Boy(s): 13	Boy(s): 14	Boy(s): 15	Boy(s): 16	Boy(s): 17	Boy(s): 18	Boy(s): 19	Boy(s): 20+
Girl(s):	Girl(s): 1	Girl(s): 2	Girl(s): 3	Girl(s): 4	Girl(s): 5	Girl(s): 6	Girl(s): 7	Girl(s): 8	Girl(s): 9	Girl(s): 10	Girl(s): 11	Girl(s): 12	Girl(s): 13	Girl(s): 14	Girl(s): 15	Girl(s): 16	Girl(s): 17	Girl(s): 18	Girl(s): 19	Girl(s): 20+

2. Classes and Activities for Children: How often would you and your children like to attend classes or activities for children?

Classes and Activities for Children: How often would you and your children like to attend classes or activities for children?   Once per week Once per month Quarterly Not at all

Other/comments:

3. Classes and Activities for Children: When is a good time for Shambhala classes or activities for your children?

Classes and Activities for Children: When is a good time for Shambhala classes or activities for your children?   Saturday morning Saturday afternoon Sunday morning Sunday afternoon Weekday evening

Other times:

4. Classes and Activities for Children:

	Crafts	Music	Dance	Yoga	Meditation	Story-telling	Dramatic Play
What kinds of activities do you think your children would enjoy with other Shambhala families and children?	*Classes and Activities for Children: What kinds of activities do you think your children would enjoy with other Shambhala families and children? Crafts	What kinds of activities do you think your children would enjoy with other Shambhala families and children? Music	What kinds of activities do you think your children would enjoy with other Shambhala families and children? Dance	What kinds of activities do you think your children would enjoy with other Shambhala families and children? Yoga	What kinds of activities do you think your children would enjoy with other Shambhala families and children? Meditation	What kinds of activities do you think your children would enjoy with other Shambhala families and children? Story-telling	What kinds of activities do you think your children would enjoy with other Shambhala families and children? Dramatic Play

Other (please specify)

5. Classes and Activities for Children: How likely is your family to participate in a "Buddhist Sunday School" provided by the center?

Classes and Activities for Children: How likely is your family to participate in a "Buddhist Sunday School" provided by the center?   Very likely Somewhat likely Unsure Somewhat unlikely Very unlikely

If likely, what would be important activities or topics to cover in Shambhala "Buddhist Sunday School"?

6. Parenting:

	Yes	No
Is child care a hindrance for you to attend classes and programs at the Shambhala Center?	*Parenting: Is child care a hindrance for you to attend classes and programs at the Shambhala Center? Yes	Is child care a hindrance for you to attend classes and programs at the Shambhala Center? No
Would you utilize child-care if it were provided during nyinthun/Sunday morning meditation?	Would you utilize child-care if it were provided during nyinthun/Sunday morning meditation? Yes	Would you utilize child-care if it were provided during nyinthun/Sunday morning meditation? No
Would you be interested in classes at the Boston Shambhala Center focused on parenting, i.e. teaching on connecting Shambhala Buddhism with family life?	Would you be interested in classes at the Boston Shambhala Center focused on parenting, i.e. teaching on connecting Shambhala Buddhism with family life? Yes	Would you be interested in classes at the Boston Shambhala Center focused on parenting, i.e. teaching on connecting Shambhala Buddhism with family life? No

Comments/suggestions:

7. Other Family Events: Would you enjoy group family events or field trips outside of the Shambhala Center?

Other Family Events: Would you enjoy group family events or field trips outside of the Shambhala Center?   Yes No

If yes, what suggestions do you have? (For example, a trip to see the Asian wing of the Museum of Fine Arts or the Lantern Festival at Forest Hills Cemetery)

8. Community Interest: Are there other people you know who should hear about new developments for Shambhala families at the Boston Shambhala Center?

Community Interest: Are there other people you know who should hear about new developments for Shambhala families at the Boston Shambhala Center?   Yes No

If yes, please list:

9. Community interest: Can we contact you about participating in family or parenting events?

Community interest: Can we contact you about participating in family or parenting events?   Yes No

If yes, please share your name and contact information here:

10. Please share any ideas you have about how the Shambhala Center could support you and your family- BIG wishes or small!

Please share any ideas you have about how the Shambhala Center could support you and your family- BIG wishes or small!