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Once Upon A Preemie: NICU NEST: Closeout Bash Survey
Thank you for your interest in the NICU NEST: Closeout Bash! We would love your feedback to help us better serve you. It only takes a few minutes. Thank you so much.
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1.
At what email address would you like to be contacted?
(Required.)
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2.
What is your first name?
(Required.)
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3.
What is your last name?
(Required.)
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4.
What is your phone number?
(Required.)
5.
Are you the parent or caregiver of a preemie?
Yes
No
6.
If yes, how many weeks gestation was your baby at birth?
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7.
What is your child’s current age?
(Required.)
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8.
What section of the city do you live in?
(Required.)
9.
Do you need assistance with transportation to attend this event?
Yes
No
10.
Will your child be attending with you?
Yes
No
Unsure
11.
What is your child’s diaper size?
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12.
Do you or your child have any food allergies or dietary restrictions? (If Yes, Please List Them)
(Required.)
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13.
Will you be bringing a guest?
(Required.)
Yes
No
14.
If yes, how many additional guests will attend?
15.
Is there anything we could do to improve this workshop?
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16.
How did you hear about this event?
(Required.)
17.
What are you most looking forward to at this event?
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18.
Are there any resources or support you are currently in need of? (Housing, Energy Assistance, Legal, Food Assistance, etc.)
(Required.)
19.
Would you like to receive updates about future NICU Nest programs?
Yes
No
20.
Do you give permission to be contacted about this event and future programs?
Yes
No
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21.
Is there anything else you'd like to share?
(Required.)
