..:::Children's Memorial and Gardens, INC:::..

	CHILDREN’S MEMORIAL AND GARDENS, Inc. A 501 (c)3 Non-Profit Organization P.O. Box 343 • Bradenton, FL 34206 (941) 749-6166 memorial4kids@att.net

Think of us as being N.E.A.R. Networking, Education, Awareness, Resources.

Your Chance to Be Heard
Online Survey

It is with great appreciation that we thank you for your time to help us. You may either fill the survey out online (below),
or click here to download a printable PDF and mail to:

Children's Memorial and Gardens, Inc.
P. O. Box 343,
Bradenton, FL 34206

Results will appear in a future edition of the CMG Newsletter and on-line the beginning of 2007.

(* indicates an optional field)

Name:		Phone:	*
State:	*	Email:

1. What brought you the greatest comfort during the first few months?

Family Friends Pastor Employer Other

2. Was your employer supportive of your needs? Scale of 1-10 (10 being highest)

How often were you absent?

Did you lose your job?

Yes No

What was your rate of productivity (1-100%) when present

3. How can an employer help you through the grieving process?

Offer flex hours for those difficult days?

Would help Already does

Offer on-site bereavement groups or counseling

Would help Already does

Offer workshop for staff to expand understanding?

Would help Already does

Remember special anniversary dates?

Would help Already does

Other:

4. Have you suffered any illnesses attributed to the death of your child?

Yes No

5. Did you have the support of your faith community? Scale of 1-10 (10 being highest)

Were you put in touch with other families who have lost a child?

Yes No

Did the Pastor visit you shortly after the service?

3 months 6 months 1 year

Were you offered any special remembrance gift?

Yes No

Please elaborate:

Does your faith community offer annual remembrance services for families who have lost children?

Yes No

6. How has your relationship changed with your:

SPOUSE:

Stronger

The Same

Struggling

Alienated

Divorced

CHILDREN:

Stronger

The Same

Struggling

Alienated

Divorced

FAMILY:

Stronger

The Same

Struggling

Alienated

Divorced

FRIENDS:

Stronger

The Same

Struggling

Alienated

Divorced

7. What would you like people to know about special dates: birthdays, holidays, anniversary dates?

How would you suggest people treat you?

8. Do you appreciate when others remember your child and share experiences with you?

Yes No

9. How would you describe your experience if you needed assistance from first responders - (fire, medics, law enforcement, victim's advocate)? Scale of 1-10 (10 being highest)

10. How have you found it best to release your grief?

Writing	Painting	Travel
Prayer	Talking About Your Child	Creating A Web Page
Joining A Support Group	Helping Others	Becoming An Advocate
Other

Are you a bereaved:

Parent Step Parent Grandparent Sibling Other

Thank you for visiting our website. We hope it offers you another avenue for healing and hope.