1.
Are you responsible for the care of any children as a parent or
carer?
Age Group
Total number of children
Number of children
with a disability / additional need
Age
Group
Total number of children
Number of children
with a disability / additional need
2 years and under
8
to 11 years
3 and 4 years
12
to 14 years
5 to 7 years
15
to 17 years
2.
Are you bringing up children on your own?
Yes
No
Are
you......
Female
Male
3.
If you work , please select from the following:
I
work full-time
I
am self-employed
I
work part-time
I
work shifts or unusual hours
4.
If you do not currently work , please select from the
following:
I
am on maternity
/ paternity leave
I
have chosen not to work
I
am looking for work
I
am a student
Taking
a career break
A
lack of childcare makes work difficult
I
do not work due to health
/ medical reasons
I
do not work due to my child's health / disability / additional
needs
5.
Please tick the boxes that apply to your partner :
My
partner works
full-time
My
partner works
part-time
My
partner works
shifts or unusual hours
My
partner is
self-employed
My
partner does not work
My
partner is
a student
6.
Are you in receipt of any of the following?
Income
Support
Lone
Parent Income Support
Incapacity
Benefit
Job
Seekers Allowance
Working
Tax Credit
Working
Tax Credit Childcare Element
Child
Tax Credit
Disability Living
Allowance
7.
Within broad bands, what is the total amount of money coming into
your household each month (after deductions)?
£500 or less
£501 to £1,000
£1,001 to £1,750
£1,751 to £2,750
£2,751 to £4,000
£4,001 or more
-- Select --
8. What are your current childcare
arrangements?
Please fill in number of days,
half-days or sessions that you usually use each week.
Number of
Full
Days used per Week
Number of
Half
Days used per Week
Daycare
- Day Nursery
Daycare
- Childminder
Registered
Nanny / Home Carer
Relative
/ friend/ neighbour
School
holiday playscheme
Number of
Sessions used per Week
Before
school care
After
school care
Playgroup / Clych Meithrin
Crèche
Other (please specify)
I
have no childcare arrangements - my children are too old to
require childcare any more
Childcare
is not needed as I care / my partner cares for our children in our
home
Any
other reason?
9.
Please tell us how much you agree or disagree with the following
statements:
I
am very satisfied with my current childcare
Strongly agree
Agree
Disagree
Strongly disagree
Don't know
-- Select --
There
is a good choice of childcare locally for different age groups
Strongly agree
Agree
Disagree
Strongly disagree
Don't know
-- Select --
The
quality of childcare locally is high
Strongly agree
Agree
Disagree
Strongly disagree
Don't know
-- Select --
Childcare
is available where I need it
Strongly agree
Agree
Disagree
Strongly disagree
Don't know
-- Select --
Childcare
is available when I need it
Strongly agree
Agree
Disagree
Strongly disagree
Don't know
-- Select --
I
can afford to pay for the childcare that I need
Strongly agree
Agree
Disagree
Strongly disagree
Don't know
-- Select --
There
is a good choice of English and Welsh-medium childcare
Strongly agree
Agree
Disagree
Strongly disagree
Don't know
-- Select --
Childcare
is available that meets all of my children’s specific needs
Strongly agree
Agree
Disagree
Strongly disagree
Don't know
-- Select --
I
prefer to use family or friends to care for my children
Strongly agree
Agree
Disagree
Strongly disagree
Don't know
-- Select --
10.
What changes, if any, would you like to see in the provision of
local childcare?
The
following information will only be used for monitoring purposes:
11.
Please describe your ethnic heritage?
White British
White/Black Caribbean
Indian
Caribbean
Any other
White Irish
White/Black African
Pakistani
African
Not stated
White (other)
White/Asian
Bangladeshi
Black (other)
Mixed (other)
Asian (other)
Chinese
Gypsey / Roma
-- Select --
Are
you also Welsh?
12.
What is your home postcode?
(eg. SA44 2WN)
Thank you for your
time. Your response will be treated in strict confidence.
We
would like to contact a selection of parents to talk in more depth
about your childcare needs. If you are willing to be contacted,
please
leave your details below. Otherwise, all replies will remain
anonymous.
Name
:
Daytime
Telephone Number :
Email (if available)
: