Bright Futures Family Resource Center
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1. Default Section
1
. What is your level of interest in using a local parenting resource center?
What is your level of interest in using a local parenting resource center?
Not at all interested
Slightly interested
Definitely interested
2
. How much would you expect to pay for a monthly fee?
How much would you expect to pay for a monthly fee?
3
. Please mark any services you would be interested in:
Please mark any services you would be interested in:
Playgroups for children
Activities for school-age children
Workshops for parents
Clothing/Toy swaps
Toy Lending Library
Parenting Support Groups
Craft/Scrapbooking Days
Moms Night Out
Dad/Child Events
Other (please specify)
4
. Please mark any services you would be willing to pay extra for:
Please mark any services you would be willing to pay extra for:
Pre/Post-natal Exercise Classes
Parent/Child Exercise Classes
Childbirth Education Classes
Beginning Breastfeeding Classes
Infant Massage Classes
Baby Sign Classes
Preschool Art Workshops
Beginning Readers Workshops
Other (please specify)
5
. Would you be interested in a space to sell locally-made or distributed items?
Would you be interested in a space to sell locally-made or distributed items?
Yes
Possibly
No
Please specify:
6
. Would you be interested in renting space for classes, workshops or meetings?
Would you be interested in renting space for classes, workshops or meetings?
Yes
Possibly
No
Please specify:
7
. Please tell us a little about yourself:
Please tell us a little about yourself:
Name:
City/Town:
Email Address :
Ages of children in your household:
8
. How far would you be willing to travel to access these services?
How far would you be willing to travel to access these services?
Less than 5 miles
5-10 miles
10-15 miles
More than 15 miles
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