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Do you have any children under 18?
 
YES
 
NO
 
 
 
How many children age 12 or younger live in your household?
 
None
 
1
 
2
 
3
 
4
 
More than 4
 
 
 
What is your child Age?
 
0-1
 
1-2
 
3-4
 
5-6
 
7-8
 
9-10
 
11-12
 
 
 
If you have children, are you are single parent?
 
yes I am not married
 
no I am married
 
I am not married but I do get support from my child(s) other parent child(ren)
 
I am not married but do get support from my significant other with my child(ren)
 
 
 
If you have children and work, what hours do you work?
 
Morning
 
Noon
 
Afternoon
 
Evening
 
Night
 
 
 
What Kind of Education want to get for your child?
 
 
Other
 
 
 
 
If you are a parent, What are you doing with your child when you need to go out alone?
 
Leave Him/Her alone.
 
Drop Him/Her to Child Care Center.
 
Leave Him/Her with Grandparents.
 
Drop Him/Her to Mom or Dad.
 
Other
 
 
 
 
If you are a parent, Are you male or female?
 
I am Male
 
I am Female
 
 
 
If you are single and If you have children, Do you prefer to send your child to 7/24 Child Care Center when you need to work at night?
 
5. Strongly agree
 
1. Strongly Disagree
 
2-4. Maybe
 
 
 
What is your child's gender?
 
Female
 
Male