How did you hear about Footsteps?FriendTVRadioNewspaperAdInternetOther
How many children need care?
What is the age of the youngest needing care?6 weeks/12 months12 months/24 months2 years/5 yearsSchool Age
What is the age of the oldest child that needs care?6 weeks/12 months12 months/24 months2 years/5 yearSchool Age
How many hours will you need care for per week?Less than 25 hoursMore than 25 hours
When will you need care to start?
Has your child been in care before?YesNo
What are you looking for in a daycare?
If there are no openings would you like to be put on a waiting list?YesNo
Please leave a number I can reach you at.
Is there anything else you would like me to know?