Exit this survey National Moms Nite Out Question Title * 1. Email address: Question Title * 2. How often do you have a night out with friends only? Once a week Once a month Twice a year Never Question Title * 3. What is your favorite activity when you're having a night out away from your family? Going to the mall, and shopping with girlfriends. Hosting or attending an in-home party. Having dinner and drinks at your favorite local hot spot. Going to the movies to catch a chick-flick. Volunteering or doing something charitable Karaoke Just being by myself and doing something I enjoy Other (please specify) Question Title * 4. How deserving do you feel you are of a Mom's night out? Extremely deserving Somewhat deserving Not deserving Question Title * 5. What tasks as a mom earns you a Mom's night out? Question Title * 6. Who would you like to spend Mom’s night out with? My best friend. A group of friends. Meeting new people. Just enjoy some alone time. Other (please specify) Question Title * 7. What is the one thing you most worry about when it's Mom's night out? Spouse will let the kids stay up too late. The kids won’t get dinner. Dad falling asleep before the kids. Incomplete homework. Other (please specify) Question Title * 8. Does your spouse or partner have a regular night out? Yes No Question Title * 9. What's your favorite color to wear on Mom's night out? Black White Red Blue Pink Other (please specify) Question Title * 10. Describe your style on Mom's night out? Jeans, T-shirt/Tank Top Mini-dress and heels Other (please specify) Question Title * 11. Updo or ponytail? Letting my hair down/natural Updo Ponytail Question Title * 12. What keeps you from dedicating a night only for yourself? Busy work schedule Lack of childcare Not enough fun options No time to get away from family Lack of money Someone to do something with Other (please specify) Question Title * 13. How do you feel when you're away from home? Guilty Relaxed Nervous Blissful Victorious, the sense of acomplishment for earning a nite off Question Title * 14. As a mom, what is the service you’d most like to receive to escape from your daily routine? Manicure and pedicure Style consultation Massage Yoga instruction Other (please specify) Question Title * 15. Where do you go to escape your daily routines? Mall Spa Park Restaurant Other (please specify) Question Title * 16. Do moms deserve a night out alone? No – children and family should be moms’ priority Yes – moms need more easy options for getting away Question Title * 17. On Mother's Day, how much time do you devote to the other mothers in your family's life? ( i.e. Your mother, grandmothers, mother in laws) A few hours The entire day None Other (please specify) Question Title * 18. How many other mother's do you celebrate with your family on or around Mother's Day? ( i.e. Mothers, grandmothers, in-laws) 1 2 3 4 5 More than 5 Other (please specify) Question Title * 19. What celebrity guy would you most like to have accompany you and your friends during a night out? Ryan Gosling Denzel Washington George Clooney Jay-Z Ryan Reynolds Marc Anthony Will Smith Ashton Kutcher Pitbull Bradley Cooper Simon Cowell Lenny Kravitz Matthew McConaughey Other (please specify) Question Title * 20. What celebrity actress/performer would you most like to have join you and your girlfriends during a night out? Jennifer Lopez Reese Witherspoon Jennifer Hudson Jennifer Aniston Eva Longoria Halle Barry Sandra Bullock Beyonce Betty White Viola Davis Angelina Jolie Jennifer Garner Other (please specify) Question Title * 21. In one sentence, describe your funniest parenting challenge or “fail”? Forgetting it was my child’s picture day at school. Rushing my child off to the bus stop on a Saturday. Not arranging for someone to pick my child up from an after-school activity. Forgetting to send my child to school with lunch. Other (please specify) Question Title * 22. What activities, if any, would you prefer to do if you could spend less time at home? Spend time with girlfriends Go shopping Exercise Go dancing Other (please specify) Question Title * 23. From a mom’s perspective, which of the following, if any, would you be willing to give up for one year in order to have a night out with friends once a week? Cell phone Internet TV Favorite snack Several nights of solid sleep Other (please specify) Question Title * 24. National Mom's Nite Out is Thursday, May 10th. How do you think you'll be celebrating your special night out? Celebrating at a local Mom's Nite Out Simon Mall event, and shopping with girlfriends. Hosting or attending an in-home party. Having dinner and drinks at your favorite local hot spot. Going to the movies to catch a chick-flick. Volunteering or doing something charitable Karaoke Other (please specify) Done
