Strengthening Families Sign Up

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1. Parent/Caregiver name(s)

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2. Name and age of Child to be in Strengthening Families

Child Name/Age

Child Name/Age

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3. What is your phone number and email address?

Phone Number

Email

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4. Do your or your child have any food allergies or dietary restrictions? If yes please specify the allergy/restriction.

No

Yes

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5. What school district does your child go to?

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6. Do you need child care for younger siblings? If yes for how many children?

No

Yes