Ready to Grow's Family Workshop Interest Survey

Thank you for your interest in the Ready to Grow workshop. This is not a registration form and you are under no obligation to attend a workshop. All information is confidential and will be used only to help us evaluate community needs.

Name
Address
County		Email address
Phone		Fax
Number of children you have
Children's ages

Please answer the following questions by choosing one:	YES	NO

Are you interested in taking a Ready to Grow Workshop?
Preferred day(s) of the week you are interested in attending:

Does your child(ren) attend a before or after-school program?
If yes, please provide organization name:

Do you have a group of parents, who would be interested in participating in the Ready to Grow workshop?
If yes, how many?

How did you learn of the Ready to Grow Service?

Thank you again for showing an interest in the Ready to Grow Service and completing this survey. You will be notified once a workshop has been scheduled. Ready to Grow is sponsored by the Department of Human Resources/Child Care Administration.