CALVARY UNITED METHODIST CHURCH
101SOUTH CHERRY STREET
P.O. BOX 229
AVILLA, INDIANA  46710
(260) 897-3190

The Child Care Ministry Board of Calvary United Methodist Church is exploring the child care needs of families in our community.  We desire to help our neighbors in response to the stresses on all families as they struggle to raise their children.  It would be appreciated if you would please print out and complete the survey below and return it by June 9th to the above address.  Thank you for your kindness.

Please indicate the number of children in your home needing each kind of care listed below.

1. Preschoolers
    ___ Full-time child care (6:00 a.m. to 6:00 p.m.)
    ___Infants/toddlers
    ___Two-year olds
    ___Three-to-Five-year olds
Days for which care is needed___________________________________________________
Hours for which care is needed__________________________________________________   
    ___Preschool (2 1/2  hour program for children aged 3 through 5.
    ___Prefer morning sessions          ___Prefer afternoon sessions
    ___Drop-in care ("as needed" child care)
Ages of child(ren) needing care__________________________________________________
Days/hours typically needed____________________________________________________

2. School-age children
    ____K____1st____2nd____3rd____4th____5th____6th____
    ___Before school (6:00 a.m. until the start of school day)
    ___After school (from the end of school day until 6:00 p.m.)
    ___During a.m. Kindergarten
    ___During p.m. Kindergarten
    ___Care only on school holidays and school dismissal days
    ___During the summer (full days)
    ___Summer program
    ___Weeks needed                        ___Hours needed

Comments___________________________________________________________________________________________
___________________________________________________________________________________________________

Name and Address______________________________________________________________________________
__________________________________________________________________________________(optional)  

Our sincere thanks for your cooperation!