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Name (Optional)
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Where/how did you hear about Tot's Line?
Brochure
Magnet
Newspaper
Website
Other:
Age
under 18
18-25
26-35
36-45
46+
Your Relationship to children
Parent
Step parent
Grandparent
Child Care Provider in Home
Child Care Provider Center
Option 6
Other:
Your Sex
Female
Male
Child 1's age and sex
Child 2's age and sex
Child 3's age and sex
Family structure
Nuclear
Single
Seperated
Blended
Other:
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