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* 1. Please provide your contact information, including name, email address, and phone number.

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* 2. How many children in your family between the ages of 6 weeks to 3 years of age might participate in Civic Center childcare?

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* 3. How many children in your family between the ages of 4 and 12 years old might participate in this service?

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* 4. What is the total number of children in your household who might participate in Civic Center childcare?

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* 5. If childcare service is available, may we contact you as a potential user?

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* 6. Should childcare become available, would you commit to childcare use for the entire season?

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* 7. Other comments?

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