Preschool Survey Form

Parent Name:*

First Name Last Name

Child(ren)'s Name(s):

Birthdate of Child(ren):

Address:*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number:*

- Area Code Phone Number

E-mail:*

Preschool: Please check all that apply:

If St. Peter had a 3-Year Old Preschool we would attend. We would be very interested in a daycare. We can only attend preschool if there is a daycare.

Please indicate the range of time you need daycare:

From To

....

If St. Peter had a 3-Year Old Preschool we might attend. Even if St. Peter has a 3-Year Old Preschool we will not attend.

Daycare: Please check all that apply:

If St. Peter had a before and after school daycare we would attend. If St. Peter had a daycare we would only use before school care. If St. Peter had a daycare we would only use after school care.

Number of children that would attend:*

....

We would be very interested in a daycare but cannot commit to attending at this time. We would not use the daycare even if one was offered.

Thank you for your time in filling this out. We will publicize and notify you of our decision as soon as possible.

In His Service,

Eric Hagenow, Principal