Clone of Head Start Fatherhood Groups and Events Interest Survey

Fatherhood Groups Interest Survey

This interest survey will help us plan our fatherhood groups, events, and activities. Thank you for your participation!
Please provide your contact information, so that we may follow up with you. *

First Name / NombreLast Name
Email
example@example.com
Phone Number
Are you interested in attending groups for dads or caregivers?*

YesNo
Are you any of the following? Check all that apply.*

FatherFather FigureTeen DadOther
Are you interested in attending a series of parent groups to offer support for day to day issues that parents face?*

YesNo
What day(s) and time(s) of the week would you prefer to attend groups and/or events? Please select your top three.*

MondayTuesdayWednesdayThursdayFridaySaturdaySunday
Are you available the same schedule every day?*

YesNo
Availability*

10am -12pm11am - 1pm12pm - 2pm2pm - 4pm4pm - 6pm5pm - 7pm
Monday Availability*

10am -12pm11am - 1pm12pm - 2pm2pm - 4pm4pm - 6pm5pm - 7pmNot available
Tuesday Availability*

10am -12pm11am - 1pm12pm - 2pm2pm -4pm4pm - 6pm5pm - 7pmNot available
Wednesday Availability*

10am -12pm11am - 1pm12pm - 2pm2pm - 4pm4pm - 6pm5pm - 7pmNot available
Thursday Availability*

10am -12pm11am - 1pm12pm - 2pm2pm - 4pm4pm - 6pm5pm - 7pmNot available
Friday Availability*

10am - 12pm11am-1pm12pm - 2pm2pm - 4pm4pm - 6pm5pm - 7pmNot available
Saturday Availability*

10am -12pm11am - 1pm12pm - 2pm2pm - 4pm4pm - 6pm5pm - 7pmNot available
Sunday Availability*

10am -12pm11am - 1pm12pm - 2pm2pm - 4pm4pm - 6pm5pm - 7pmNot available
What location would you prefer for meetings, groups, and events?*

Family Forward Office (5751 Uptain Rd., Chattanooga, TN)Signal Centers' Main Location (109 N. Germantown Rd., Chattanooga, TN)Local Community Center/sOther
Local Community Center Name
What would increase the likelihood that you would attend the meetings and/or events? Please check all that apply.*

$20-$300 gift card for workshop completionTransportation providedGas cardChildren ActivitiesDoor prizesFood/snacks providedOther
If you need child care during meetings and/or events, please list your children and their ages.
How far in advance would you like to receive a notice about upcoming events?

1 month2 weeks1 week
What are your topics of interest?
What are your activities of interest?
Should be Empty:

Fatherhood Groups Interest Survey