Beaufort-Jasper Eoc Head Start

Family Communication Plan

Date:
What program option are you registering for?*

Center:*

Parent's First Name:*
Parent's Middle Name:
Parent's Last Name:*
Secondary Parent/Guardian Name (if applicable):

Child's First Name:*
Child's Middle Name:
Child's Last Name:*

Contact Information
Mother Telephone:
Father Telephone:
Mother Email:
Father Email:

Parent Employment/School Information
1. Are you currently employed?
If yes,   
   
2. Place of Employment:

3. What days of the week do you work? (check all that apply)    
 
 
 
 
 
 
4. Are you currently in school?
If yes,   
   
5. What days of the week do you attend? (check all that apply)    
 
 
 
 
 
 

Technology Access
1. What devices do you have at home to access the internet? (check all that apply)
   
 
 
 
 

2. Do you have internet service at home?
3. Are you familiar with Zoom?


Parent Schedule
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)?
Days of the Week:   
 
 
 
 
Morning Hours (am):  
 
 
 
Afternoon Hours(pm):  
 
 
 
 
Evening Hours (pm):   
 
 
Specific schedule that will work the best:

2. What will be the best time of the week to have a parent events or meetings at your child’s center?
Days of the Week:   
 
 
 
 
Morning Hours (am):  
 
 
 
Afternoon Hours(pm):  
 
 
 
 
Evening Hours (pm):   
 
 
3. What will be the best time of the week to participate in virtual events (via Zoom)?
Days of the Week:   
 
 
 
 
Morning Hours (am):  
 
 
 
Afternoon Hours(pm):  
 
 
 
 
Evening Hours (pm):   
 
 

Child Resources
1. How do you prefer to receive the child learning activities?   
 
 

Parent Interest
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?

3. What parent groups would you be interested in?    
 
 

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. *

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Parent Signature
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