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* 1. Name of person completing survey:

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* 2. Email 

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* 3. Phone Number

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* 4. I work in the following district building:

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* 5. Names & grades of children:

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* 6. My children attend the following Dallas school/s:

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* 7. My children are enrolled in or planning to participate in:

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* 8. I am interested in enrolling my children in the on-site school age child care program for the 2020-2021 school year:

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* 9. Our family will need care:

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* 10. Which of the following hours of operation would best meet your needs?

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* 11. Do you have any other comments, questions, or concerns?

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