Interest Survey
Parents’ Morning Out (PMO)

The women’s group of our church is organizing an eight-week pilot Parents’ Morning
Out (PMO) program that will run from _________ to __________. The group (or
groups) will consist of eight to twelve other parents and their preschool children,
including children who are just completing kindergarten. The children will play/sing/hear
stories at church in the ______ room one morning each week from 9:00 a.m. to noon.
Two or three parents will be assigned to supervise the children each week (participants
will provide childcare one morning and have three mornings free in a month).

If you think that you might be interested in joining a PMO group, please complete this
questionnaire and return it to _______________, or to the church office, by (date)_____.

Please check all that apply:

I am:
  _____strongly interested in joining the PMO group
  _____somewhat interested in joining the PMO group
  _____interested if the morning is right for me
  _____not interested now but may want to join a PMO group later

The age(s) of my child(ren) as of (date)__________ (check all that apply):

My preference for a morning to meet is:
 _____Monday _____Tuesday _____Wednesday _____Thursday _____Friday

I would be most likely to participate in a group where the children are the following ages:
  _____birth to 36 months
  _____18 months through 4 years
  _____3 years through 6 years
  _____birth through 6 years
  _____other: ________________

Other suggestions or comments regarding a PMO group: ________________________

Circle one:
 I am/ am not a member of the _______________(name of church women’s group)
 I am/ am not a member of the _______________(name of the church)