This survey from Debby Ann Jeffery's book Literate Beginnings: Programs for Babies and Toddlers can be adapted to fit your needs.
******************************************************
Sample Baby-Toddler Program Questionnaire
Date____________________
Thank you for taking the time to fill out this questionnaire. Your answers will help plan future programs for you and your child.
Name____________________________________________________(Optional)
Address__________________________________________________(Optional)
- How many children attend the program with you? ___________________
- Child/children’s ages? _________________________________________
- What is your relationship to the child? ___________Parent/legal guardian
___________Other family member ___________Babysitter/nanny
___________Other (please specify)______________________________
- Where did you find out about the Baby-Toddler Program?
___________Library Flyer/poster ___________Friend/neighbor
___________Other (please specify)______________________________
- Is the program day and time convenient for you? _____Yes _____No
If no, when would be a better day and time? _________ Saturday
___________Weekday (please specify) ___________________________
___________Morning __________Afternoon ___________Evening
- Did you feel the material was appropriate for the children?
Books _____Very _____Somewhat _____Not appropriate
Finger Games _____ _____ _____
Songs _____ _____ _____
Puppets/Feltboard ______ _____ _____
Film/Video ______ _____ _____
- Do you find the program handout sheets helpful during the program?
______Yes ______No ______Sometimes
- Do you find it helpful to take he program handout sheets home?
______Yes ______No ______Sometimes
- How often do you repeat elements from the program at home?
______Often ______ Sometimes ______ Never
- Has your child’s interest in books, songs, and finger games changed
since attending the program?_____No Change ______More interested
______Less interested
- Since attending the program, do you spend more time with your child?
Reading books? ______Yes ______No
Singing? ______Yes ______No
Doing finger games? ______Yes ______No
- Did you have a library card before you attended the program?
______Yes ______No
- Did your child have a library card before you began attending the
Program? ______Yes ______No
- Do you check library materials out when you attend the program?
______Yes ______No
- Would you recommend this program to other people with young children?
______Yes ______No
- What do you like best about the program?
- What do you like least about the program?
- Do you have any suggestions or comments?