Social-Emotional Learning & Support Workshop, Tuesday, 5-7-24, FREE Dinner (optional) 5:30-6:00pm, Workshop 6:00-7:15pm @ Putnam Elementary School, 33 Wicker St. Putnam, CT 06260

Registration Form

The Northeast Early Childhood Council (NECC) has partnered with the Putnam Family Resource Center & EASTCONN Head Start to offer a FREE Social-Emotional Learning (SEL) & Support workshop to families with one or more children, ages 2-8 years (adjusted developmental age) and who live in any of the following towns: Brooklyn, Canterbury, Killingly, Plainfield, Putnam, Sterling & Thompson, CT.

Families who attend the event will receive a FREE Social-Emotional Learning (SEL) Kit for their child(ren). One SEL Kit per family.

Thank you to our community partners for their generous donations!

This workshop is supported by the Putnam Family Resource Center, EASTCONN Head Start, the CT Office of Early Childhood, the CT Children's Collective and the CT towns of Brooklyn, Canterbury, Killingly, Plainfield, Putnam, Sterling, and Thompson as well as other generous, local donors.

After your registration is submitted, we will contact you to confirm your registration prior to the event by either text, phone call or e-mail from Christine @ 860-717-2009 or rosatirandall@outlook.com.

This is important as space is limited.

Question Title

* 1. Please check all that apply. I am a...

Parent (biological/stepparent)

Grandparent

Foster parent

Other caregiver (please specify)

Question Title

* 2. Please indicate the age(s) of your child(ren) by checking all that apply. (Include actual or adjusted developmental age)

2 years old

3 years old

4 years old

5 years old

6 years old

7 years old

8 years old

Other, adjusted developmental age (if applicable)

Question Title

* 3. Please provide your contact information to confirm your registration. This project is grant funded. You may be contacted in the future for anonymous feedback on the SEL workshop and the usefulness of the SEL Kit.

Name *

City/Town *

ZIP/Postal Code *

Email Address *

Phone Number

Question Title

* 4. If additional adults are attending, please include their name(s) below:

Question Title

* 5. Please check all that apply.

My child is NOT enrolled in any type of early learning program (Preschool, Elementary School, Head Start, Home Visiting, Home-schooling)

My child attends a private daycare (home or center-based)

My child attends a preschool or Head Start center-based program

My child attends elementary school

My child is enrolled in one of these home visiting programs: DKH Nurturing Families Network, Family Resource Center Parent Educator, Head Start Home visiting, TEEG Hand-in-Hand, Child First

My child is home-schooled

Other (please specify)

Question Title

* 6. To assist us in providing relevant information to best support your needs, can you tell us what your family or your child is experiencing? Check all that apply.

Anxiety

Depression

Bullying

lack of socialization (isolation)

insufficient social skills

Difficulty with emotions

loss of loved one

Autism

ADHD

homelessness or unstable housing

I prefer not to answer

None of the Above.

Other (please specify)

Question Title

* 7. Have you previously heard about the CT Office of Early Childhood (OEC) Sparkler app that helps parents check in on how their child is doing against key milestones — and provides activities to spark their early learning?

Yes

Unsure

Question Title

* 8. If yes, please check all that apply.

I have signed my child(ren) up in the Sparkler app.

I have used one or more of the play activities in the app to support my child(ren)'s development.

I am aware that there is an ASQ-SE (Ages & Stages Social-Emotional) screening tool in the Sparkler app. that I can complete at home, that identifies infants and young children whose social and emotional development may require further evaluation to determine if referral for intervention services is necessary.

I have signed my child(ren) up in the Sparker app. but have not used the play activities.

I have signed my child(ren) up in the Sparkler app. but have not completed an ASQ-SE.

I am not sure how to navigate the features in the Sparkler app.

I do not understand the benefits of utilizing the Sparkler app. for my child(ren).

Additional Comments: (please fee free to share other comments about the Sparkler app. and/or elaborate on your responses)

Question Title

* 9. What do you hope to gain from this workshop for your child(ren) and/or your family?

Question Title

* 10. Do you and/or your child(ren) plan to participate in the free dinner option from 5:30-6:00pm? Dinner consists of boneless chicken breast, penne pasta, salad, rolls & dessert.

Yes

Unsure at this time

Question Title

* 11. If yes, please indicate the number of adults, including yourself, and children participating in the dinner. Also, please let us know if there are any dietary restrictions or food allergies.

Question Title

* 12. On-site childcare is provided for the participant's children, ages 2 & up. Please provide the ages of children that will be in childcare. If none, please enter zero.

Childcare for children under the age of 2 is not available but they are welcome to stay with their caregiver.

Question Title

* 13. Is there anything else that you would like us to know to help create a supportive environment for you and your child(ren) during this workshop.

Question Title

* 14. Can you tell us how you learned about this workshop? For ex., Name of Facebook page or group, flyer from (name of) school, word of mouth, etc.
This information can help us identify effective ways to share information with our local families.

Social-Emotional Learning & Support Workshop, Tuesday, 5-7-24, FREE Dinner (optional) 5:30-6:00pm, Workshop 6:00-7:15pm @ Putnam Elementary School, 33 Wicker St. Putnam, CT 06260

Registration Form

Question Title

* 1. Please check all that apply. I am a...

Question Title

* 2. Please indicate the age(s) of your child(ren) by checking all that apply. (Include actual or adjusted developmental age)

Question Title

* 3. Please provide your contact information to confirm your registration. This project is grant funded. You may be contacted in the future for anonymous feedback on the SEL workshop and the usefulness of the SEL Kit.

Question Title

* 4. If additional adults are attending, please include their name(s) below:

Question Title

* 5. Please check all that apply.

Question Title

* 6. To assist us in providing relevant information to best support your needs, can you tell us what your family or your child is experiencing? Check all that apply.

Question Title

* 7. Have you previously heard about the CT Office of Early Childhood (OEC) Sparkler app that helps parents check in on how their child is doing against key milestones — and provides activities to spark their early learning?

Question Title

* 8. If yes, please check all that apply.

Question Title

* 9. What do you hope to gain from this workshop for your child(ren) and/or your family?

Question Title

* 10. Do you and/or your child(ren) plan to participate in the free dinner option from 5:30-6:00pm? Dinner consists of boneless chicken breast, penne pasta, salad, rolls & dessert.

Question Title

* 11. If yes, please indicate the number of adults, including yourself, and children participating in the dinner. Also, please let us know if there are any dietary restrictions or food allergies.

Question Title

* 12. On-site childcare is provided for the participant's children, ages 2 & up. Please provide the ages of children that will be in childcare. If none, please enter zero. Childcare for children under the age of 2 is not available but they are welcome to stay with their caregiver.

Question Title

* 13. Is there anything else that you would like us to know to help create a supportive environment for you and your child(ren) during this workshop.

Question Title

* 14. Can you tell us how you learned about this workshop? For ex., Name of Facebook page or group, flyer from (name of) school, word of mouth, etc. This information can help us identify effective ways to share information with our local families.

* 12. On-site childcare is provided for the participant's children, ages 2 & up. Please provide the ages of children that will be in childcare. If none, please enter zero.

Childcare for children under the age of 2 is not available but they are welcome to stay with their caregiver.

* 14. Can you tell us how you learned about this workshop? For ex., Name of Facebook page or group, flyer from (name of) school, word of mouth, etc.
This information can help us identify effective ways to share information with our local families.