A group of community members is working to identify what the child care needs are in our community and obtain solid data about how the possible lack of child care opportunities is affecting your business and employees. Please answer as fully as possible.

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* 1. Employer/Business Name:

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* 2. Number of employees

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* 3. How many of your staff members have children (0-12 years of age)?

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* 4. Do you offer any of these assistance/supportive measures to your employees?

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* 5. How often have you had an employee bring a child to work because they do not have child care?

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* 6. How many employees or potential employees have you lost due to lack of child care?

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* 7. What child care related challenges has your business faced?

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* 8. What community resources would you like to see made available to help with child care issues?

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* 9. Thank you so very much for contributing your business' information as we strive to better understand the employer and employee needs around child care in our community. Please let us know if there is anything else you would like us to know or questions you might have.

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