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ABOUT
SCIENCE
CREATIVITY
OUTSOURCE
INSIGHTS
CONTACT
ABOUT
SCIENCE
CREATIVITY
OUTSOURCE
INSIGHTS
CONTACT
Thank you for your interest in our focus group.
Please fill in the form below for consideration.
CHC Parent Form
Full Name
*
Email
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Phone
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Zip Code
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Do you have children in childcare?
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Yes
No
Ethnicity (to make sure all are represented in our discussions)
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Hispanic/Latino
African American
Asian
Native American
White
Multiple/Other
Prefer Not to Say
Select all that apply.
Your Availability:
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Weekdays
Early Evening
Weekend
What organization referred us to you?
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Select One...
Boys & Girls Club of Southern Nevada - UNLV Clubhouse
Jydstrup Elementary School
Catholic Charities of Northern Nevada/Thriving Families
Boys and Girls Club of Truckee Meadows
Boys & Girls Club of Western Nevada
Boys & Girls Club of Fernley
Fernley Community Foundation
Boys & Girls Club of Mason Valley
Boys & Girls Club of Elko/Spring Creek/Wells
Las Vegas Indian Center
Great Basin College Child Center
Department of Children & Family Services / Elko Office
Other
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