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* 1. Where do you live?

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* 2. How many children, by age, currently live in your household?

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* 3. Which of the following programs would benefit your family? Pick more than 1 if needed.

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* 4. What challenges are you facing with your children? Pick more than 1 if needed

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* 5. Do you have any suggestions of any other parenting program or service that you would like to see in Apollo Bay?

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* 6. Programs are generally 6 weeks long and delivered in the evenings between 7-9pm. Please give an indication of evenings that would suit you. Pick more than 1 if needed.

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* 7. Any other comments?

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