St. Elizabeth Ann Seton Catholic Church/Naamah's Mama's Ministry Interest Survey/Plano, TX

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Email REQUIRED Please fill out this field. Please enter an email address.

Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Husband's Name (if applicable) Please enter valid data.

1. How long have you been a member of St. Elizabeth? REQUIRED Less than 6 months 6 months - 1 year 1-2 years 3 or more years Please fill out this field.

2. How many children do you have? REQUIRED 1 2 3 4 or more Please fill out this field.

3. How old are your children? - check all that apply I'm pregnant! Infant (under 2 years old) Preschool (2-5 years old) Elementary School aged Middle School aged High School aged College aged or older

4. What is your work status? REQUIRED I'm a stay at home mom I work from home part time I work from home full time I work outside the home part time I work outside the home full time Please fill out this field.

5. Ideally, how often would you like to have a General Meeting? Once per month Twice per month No preference

Other topics of interest:

7. Of the following days and times listed below, please rank your preferred day/time to attend a general meeting:
1=highest, 10=lowest

Monday - Late Morning REQUIRED Please fill out this field.

Monday - Evening REQUIRED Please fill out this field.

Tuesday - Late Morning REQUIRED Please fill out this field.

Tuesday Evening REQUIRED Please fill out this field.

Wednesday - Late Morning REQUIRED Please fill out this field.

Wednesday - Evening REQUIRED Please fill out this field.

Thursday - Late Morning REQUIRED Please fill out this field.

Thursday - Evening REQUIRED Please fill out this field.

Friday - Late Morning REQUIRED Please fill out this field.

Friday - Evening REQUIRED Please fill out this field.

8. What obstacles would you anticipate facing that could prevent you from attending a General Meeting?

9. Is there something that this group could do to help you overcome the above mentioned obstacles?

10. Are you currently a member of a Moms' Support type group, including a formalized playgroup? REQUIRED Yes No Please fill out this field.

If yes, are you aware of any other members from St. Elizabeth? Yes No

Other activity interests:

12. What sort of media are you a member of or do you use regularly? - please check all that apply Facebook Google Groups Twitter Whatsapp Other - please specify below

Other Media Type: Please enter valid data.

13. Please use the following space to provide any additional comments, suggestions, or feedback you may have.