Fatherhood Initiative Survey

Name *

First Name

Last Name

May we send you info about events to this email address?

Choose one:

Yes

No

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

How often do you come to the Greater Hazelwood Family Center? *

Every day

4 to 5 times per week

3 or fewer times per week

First time

What type of experiences would you like to have during the Fatherhood Initiative? *

Field trips/outings

Presentations such as: health & nutrition/ community involvement, parenting, legal services, career services, etc.

Automotive information

When is the best time of the day for you to be able to attend programming? *

Mornings

Afternoons

Evenings

When would you be available to attend family center field trips? *

During the week in the afternoon

During the week in the evening

Weekends