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Thanks for Considering this Opportunity :)

This survey is for the opportunity to have me work with your family for free, in exchange for that experience to be filmed on your phone. What is filmed will then be shared with television producers, but never with the larger public. The following questions will help us both assess whether or not this opportunity will be a good fit for you and your family. 💛

This form should take approximately 15 minutes to complete.

Start

Question 1 of 9

< PLEASE NOTE: IF YOU PRESS "BACK" THIS FORM WILL RESTART. >

 

Question 1 of 9: How many children do you have? What are their ages? 

Question 2 of 9

Question 2 of 9: What might be helpful for me to consider about the makeup of your family? (Married / divorced / single parenting / BIPOC / LGBTQ+ / medical diagnoses, history of trauma) Anything at all that significantly shapes the experience of your parenting...

 

Question 3 of 9

Question 3 of 9:  What is the biggest challenge you face in parenting, and how are you currently handling it? (You know, those moments that make you scream in a pillow or wish you could go live on a mountaintop alone somewhere?)

Question 4 of 9

Question 4 of 9:  Please tell me a story about how this plays out. What time of day? How often? What exactly does this look like in your home? Why do YOU think this problem persists? What do you WISH it looked like instead?

Question 5 of 9

Question 5 of 9: What techniques have you tried so far to get help? What has helped, and what hasn't?

Question 6 of 9

Question 6 of 9: If we do this experiment together, I will need you to record what is happening on your phone. Are you willing and able to use a phone to capture this event occurring?

A

Yes

B

No

Question 7 of 9

Question 7 of 9: Are you willing to share this recording privately with the television producers?  Please note: this recording will be used to help them envision the production ONLY. What we record together will be safe and never shown on public television.  

A

Yes

B

No

Question 8 of 9

Question 8 of 9: How familiar are you with my work? Have you worked with me before, do you follow the podcast, have you just found me and are wondering where the heck I have been all these years you were crying in the bathroom alone? Are you able to trust me as we do this crazy experiment together?

Question 9 of 9

Question 9 of 9:  Anything else you want me to know?

Confirm and Submit