What program option are you registering for?*
Secondary Parent/Guardian Name (if applicable):
Parent Employment/School Information
2. Place of Employment:
2. Do you have internet service at home?
3. Are you familiar with Zoom?
Child Care Center Name:
2. Will your child have supporting people to assist with daily activities?
If Yes, List the names below of who will be helping your child
1. When is the best time to check in with you and your child during the week by phone or virtual meeting:(check all that apply)?
Specific schedule that will work the best:
2. What is the best time of the week to have a Classroom Connections Meeting or Short Parent Workshop?
1. I would be interested in the following short parent workshops (check all that apply):
2. Would you be interested in holding an office on the Parent Committee at your child’s school to help plan activities for children and families?
4. Would you be interested in joining the Parent Policy Council? You will be in a group with other parents who make important decisions about the Head Start Program?
Additional parent notes you want to share:
I confirm that I have read and understand this form. *