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* 1. Name (optional)

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* 2. How many children do you have?

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* 3. What are your children's ages?

  child 1 child 2 child 3 child 4 
children's ages

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* 4. Have you used the service before?

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* 5. If yes, do you currently still use the service?

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* 6. If no, what would be your main barrier / reason for not using the service?

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* 7. what room/s do you currently use within the service?

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* 8. If you are interested in using the service, what would be your reason for using it?

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* 9. What are the preferred hours you would require?

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* 10. If you are interested in using the service what days would you require?

  Monday Tuesday Wednesday Thursday Friday
Child Under 3 - full day
Child Under 3 - half day
Child Under 3 - casual care (if space available)
Child Over 3 - full day
Child Over 3 - half day
Child Over 3 - casual care (if space available)
After School Care

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* 11. If the service offered additional programs what would you be likely to use?

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* 12. If you currently use or intend to use the service would you require care during the December/January period?

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* 13. Would you be interested in contributing to the service and the care provided to your child/ren by joining a Parent Advisory Committee (PAC) that meets with Early Years Management?

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* 14. If yes, what days/times would you be available to attend PAC meetings?

  Monday Tuesday Wednesday Thursday Friday
Days and times

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* 15. What activities would you like offered for your child/ren and what outcomes would you like to get from these activities?

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* 16. How would you like this information fed back to you?

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* 17. If there is an outbreak of illness how would you prefer to be notified of this?

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* 18. How long when dropping off and picking up your child would you like to spend with the educator to discuss your child's routine and needs?

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* 19. Do you have any ideas or suggestions for improvement that will help ensure that Warracknabeal Early Learning Centre is a viable and preferred option for all childcare needs?

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* 20. What room/program have you used within the service?

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* 21. If you would like someone from the Wimmera Uniting Care Early Years to contact you to discuss your childcare needs please leave your name and contact number in the space below.

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* 22. When there is staffing changes how would you like to be notified of this?

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* 23. How regularly would you like to receive surveys for your input into how and what is run at the centre and the purchase of equipment?

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