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How many people are you a parent or caregiver for?
1-2
3-4
5-6
7 or more
What ages are the people for whom you are a parent or caregiver? Check all that apply.
Less than 1 year old
1-3 years old
4-6 years old
7-10 years old
11-14 years old
15-18 years old
other
What are some parenting/caregiving topics on which you would appreciate educational talks or information? Check all that apply.
Parenting multiples
Parenting children with disabilities
Breastfeeding support
Being a foster/adoptive parent
Other
Other
Other
Other
Other
Which of the topics listed above (including ones you added) would you be willing to organize or help lead a casual "coffee club" type social/support group?
What types of social events would you be most interested in? Check all that apply!
Casual coffee
Special Situation Support Group (please specify your situation)
Play dates with children
Walking with other parents (children excluded)
Walking with other parents (children included)
Other
Other
Other
Please describe below how this group can be MOST helpful to you.
We want to make sure that the times of meetings or other events are convenient. Please choose the times when you would be able to participate in a meeting or other event (meetings will not be longer than 1 hour). Check all that apply.
Monday early morning
Wednesday early morning
Friday early morning
Monday late morning
Wednesday late morning
Friday late morning
Monday lunchtime
Wednesday lunchtime
Friday lunchtime
Monday early afternoon
Wednesday early afternoon
Friday early afternoon
Monday late afternoon
Wednesday late afternoon
Friday late afternoon
Monday evening
Wednesday evening
Friday evening
Tuesday early morning
Thursday early morning
Saturday morning
Tuesday late morning
Thursday late morning
Saturday afternoon
Tuesday lunchtime
Thursday lunchtime
Saturday evening
Tuesday early afternoon
Thursday early afternoon
Sunday morning
Tuesday late afternoon
Thursday late afternoon
Sunday afternoon
Tuesday evening
Thursday evening
Sunday evening
What is your gender?
Male
Female
Please provide us with your contact information so that we can keep you informed about meetings and events.
Name
E-mail
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