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Keokuk Parent Cafe

Wednesday, August 16th - "My Circus, My Monkeys: Conquering Chaos"

Thank you for registering to join us! Please answer all questions to the best of your ability. If you have any questions or issues with registering, please email thebestyoucoalition@gmail.com or text 319-795-2126 (Amanda Rogers).
1.First and Last Name.(Required.)
2.Phone Number.(Required.)
3.Email Address.(Required.)
4.Name(s) - First and Last, Phone Number(s), and Email(s) of other ADULTS who will attend with you.
5.Name(s), and Age(s) of CHILDREN who will attend with you.
6.Are there any dietary concerns for yourself, other adults, or children attending this event? If YES, please describe. If NO, please type in N/A.(Required.)
7.Are there any special needs or concerns that staff should know about for children attending with you? If YES, please include child's name, age, and a brief description of need(s)/concern(s). If NO, please type in N/A.(Required.)
8.How did you hear about this Keokuk Parent Cafe?(Required.)