COVID 19 Childcare Assistance Question Title * 1. Are you considered an essential employee that is required to work during the COVID 19 Pandemic? Yes No Question Title * 2. Do you have children below the age of 12 that require childcare? Yes No Question Title * 3. Do you currently have your childcare needs met? Yes No Question Title * 4. If you had an alternate means of childcare available, would you pay a minimal fee to use it? Yes No Other (please specify) Question Title * 5. What are the age ranges of your children? Please check all that apply. Newborn - 1 1/2 years 1 1/2 years - 3 years 3 years - 5 years 5 years - 8 years 8 years - 12 years Question Title * 6. What shift do currently work and would need childcare to cover? Check all that apply. Day shift Evening shift Night shift Weekends Other (please specify) Question Title * 7. Do you have any other comments that would help us better address childcare needs for essential workers? Question Title * 8. What locality do you reside in currently? Buchanan Dickenson Russell Tazewell Lee Scott Wise City of Norton Other (please specify) Done