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Pact Family Survey

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* 1. Does your family have enough food to adequately provide three well-balanced meals?

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* 2. Is your infant/toddler in need of diapers and/or wipes?

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* 3. As a result of the Stay at Home proclamation, have the working hours at your job been reduced or have you been laid-off?

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* 4. Do you or will you in the near future need assistance paying your utility bills?

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* 5. Do you or will you in the near future need assistance paying your rent or mortgage payment?

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* 6. Have you and your child completed at least one activity and/or listened to at least one book available PACT Facebook Page?

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* 7. Have you and your child been able to take walks and/or participate in physical activity three or more times each week?

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* 8. During this time of social distancing, have you been able to connect with family and friends through social media and/or phone?

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* 9. Name

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* 10. Contact info:

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