* 1. Would you be you interested in having your child or children attend  Boys and Girls Club in the South Whidbey community?

* 2. Please provide your contact information if you would like more information.

* 3. If a before school program was offered, would you sign up for it?

* 4. If yes, what is the earliest time you would need to drop off your child?

* 5. If yes, would you be able to pay $200+/ month for a before school program?

* 6. Would you be interested in before school program scholarship opportunities, if you meet eligibility requirements?

* 7. If an after school program was offered, would you sign up for it?

* 8. If yes, what is the latest time you would need to pick up your child?

* 9. If yes, would you be able to pay $200+/month for an after-school program?

* 10. Would you be interested in after-school program scholarship opportunities, if you meet eligibility requirements?

* 11. Would you be able to pay $300+/month for the before and after school program?

* 12. Would you be interested in before and after school scholarship opportunities, if you meet eligibility requirements?

* 13. Indicate the grade level of your children in your care who you would like to enroll in a Boys and Girls Club program.

* 14. Any comments you would like to share with the Boys & Girls Club?

* 15. Please tell where you live.

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