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  Child Care Referral Follow Up Form

Thank you for consulting with Virginia Child Care Resource & Referral Network for child care referrals.  Please take a moment to fill out this form and submit it to us.  VACCRRN relies on this follow up information for many purposes; the greatest purpose of all is to server parents and their children better. We thank you in advance for your time in filling out this form.


Your Zip Code      

 


1.  Would you say the quality of your child care options were:

Choose One Excellent    Very Good    Good    Fair    Poor

 


2.  Would you say the quality of your current care is:

Choose One Excellent    Very Good    Good    Fair    Poor


3.  Would you say the quality of Child Care Resource and Referral is:

Choose One

High Quality Counseling    Adequate Quality Counseling    Poor Quality Counseling

High Quality Information    Adequate Quality Information    Poor Quality Information

 


4.  Do you feel you were able to make a better decision on child care based on our services/counseling?

Choose One Yes    No

 


5.  Satisfaction with the child care information received:

Choose One Excellent    Very Good    Good    Fair    Poor

 


6.  Courtesy and helpfulness of our staff, if consulted:

Choose One Excellent    Very Good    Good    Fair    Poor    Not consulted

 


7.  What type of child care do you think you will choose:

Choose One

Child care center    Home provider    Head Start program    After school   

Preschool program    Relative/Friend    In my home/Nanny

 


8.  Did you have any problems with your child care search:

Choose One Yes    No
If Yes please select the problems you encountered, check all that apply Available Hours    Location    Quality    Transportation    Cost    No Openings

 


9.  Which of the following indicators do you use in choosing child care:

Check all that apply Caregivers/Teacher    Activities    Setting/environment    Cost    Extras


10.  How satisfied are you with your child care:

Choose One Very Satisfied    Satisfied    Somewhat satisfied    Not satisfied

 


11.  Status of child care search:

Choose One Still Looking    Decided not to select child care at this time    Found other source

 


12.  Would you ever use our services again:

Choose one Yes    No

 


13.  Please rate the accuracy of the information given:

Choose One Accurate    Inaccurate

 


14.  What could we do to improve our services:

This form will be emailed to VACCRRN by clicking on the Submit button below:

 
© 2004 Virginia Child Care Resource & Referral Network. All rights reserved.