What is your relationship to the child(ren) you care for? * > (Select One) Parent Grandparent Uncle Aunt Family Friend Other Are you a single parent/caretaker? > (Select One) Yes No Do you work? If so, > (Select One) Full-time Part-time If Yes, How Many Hours? How many children do you care for, and what are their ages? Does your child(ren) attend public school, private school, or homeschool? > (Select One) Public School Private School Home School Do they participate in extracurricular activities? If so, what activities? Does your child(ren) have a disability or any special needs? If so, please select > (Select One) Autism ADD/ADHD Receptive/Expressive Language Disorder Cerebral Palsy Other (please name below) Please Name How can the church support you? How often do you sit down as a family and eat a meal together? Pick one: > (Select One) Never 1-2 times per week 3-4 times per week 5 times per week
On a scale from 1 to 10 (1="Not at All" and 10="Completely Comfortable"), answer the following questions.
How comfortable are you talking about the Bible with your child? How comfortable are you leading your child to Christ? How comfortable are you praying out loud with your child How many years have you been attending church? Check one: > (Select One) 1 year or less 2 years 2 - 4 years 5-8 years 10+ years How often do you attend church as a family? Check one: > (Select One) Every time the doors open Once a week Twice a week Once a month Other Do you have a Bible in your home? > (Select One) Yes No How often do you read your Bible during the week? Check one: > (Select One) Daily 1-2 times a week 3-4 times a week 5-6 times a week Other How often do you pray during the week? > (Select One) Multiple times a day Once a day Just before eating Do you pray together as a family during the week? > (Select One) Yes No If Yes to the above, how often? When you miss church, which of the following is the closest reason why? > (Select One) Family vacation Travel Sports Transportation Issues Lack of interest Other What would you say is your biggest struggle in raising your children? In what ways can the youth and children's ministries help you with your children? When we host parenting workshops/small groups, what topics would be of interest to you? Check all that apply: Thank you for completing this survey. If you would like for a youth or children's ministry leader to contact you regarding your children, please leave your name and contact information below: Phone Number Email Address What is the best time to reach you?