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Positive Parenting Pilot Survey
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* Indicates required question
Email
*
Your email
Parents (who want to attend this class) name:
*
Your answer
Phone Number:
*
Your answer
Names, Date of Birth(s), and gender of all children under the age of 3 years:
*
Your answer
Do you have any older children?
*
Yes
No
Are you available to participate in classes 1 x a week between February 9th & April 20th (excluding Spring Break the week of April 6th)?
*
Yes, excluding an emergency, I could participate in all 10 sessions
Yes, excluding an emergency, I could participate in at least 8 of the sessions
No, I would probably only be able to participate in 7 or less sessions during that period
The team who will be leading this group are available to hold these sessions at these times. Will you please check ALL that would work for you:
*
Tuesdays, 8 – 9:30 a.m.
Tuesdays, 8:30 – 10 a.m.
Tuesdays, 9 – 10:30 a.m.
Tuesdays, 9:30 – 11 a.m.
Tuesdays, 10 – 11:30 a.m.
Tuesdays, 10:30 – 11 a.m.
Tuesdays, 12:30 – 2 p.m.
Tuesdays, 1 – 2:30 p.m.
Tuesdays, 1:30 – 3:00 p.m.
Tuesdays, 2 – 3:30 p.m.
Tuesdays, 2:30 – 4 p.m.
Thursdays, 8 – 9:30 a.m.
Thursdays, 8:30 – 10 a.m.
Thursdays, 9 – 10:30 a.m.
Thursdays, 9:30 – 11 a.m.
Thursdays, 10 – 11:30 a.m.
Thursdays,, 10:30 – 11 a.m.
Thursdays, 12:30 – 2 p.m.
Thursdays, 1 – 2:30 p.m.
Thursdays, 1:30 – 3:00 p.m.
Thursdays, 2 – 3:30 p.m.
Thursdays, 2:30 – 4 p.m.
Fridays, 8 – 9:30 a.m.
Fridays, 8:30 – 10 a.m.
Fridays, 9 – 10:30 a.m.
Fridays, 9:30 – 11 a.m.
Fridays, 10 – 11:30 a.m.
Fridays, 10:30 – 11 a.m.
Fridays, 12:30 – 2 p.m.
Fridays, 1 – 2:30 p.m.
Fridays, 1:30 – 3:00 p.m.
Fridays, 2 – 3:30 p.m.
Fridays, 2:30 – 4 p.m.
Required
While you are available all the times that you checked above, please list your top 1 – 3 preferences below for when we schedule the class.
*
Your answer
I have the ability to use a reliable internet connection and camera access to connect to this group using a (check all that apply):
*
Desktop Computer
Laptop Computer
Notebook
I-Phone
Required
If I am not selected to be part of the Positive Parenting pilot, I would consider participating in the “control” group?
*
Yes
No
Maybe - I have some additional questions about it
Send me a copy of my responses.
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