Coordinated Family and Community Engagement FALL PLAYGROUP REGISTRATION FORM

Registration Form

Playgroups provide time child and their families with the opportunity to interact with other children, develop social skills, and language. Each week we will sing songs, read stories, and engage in movement activities together. We will provide materials for follow up activities for you and your child do together until we are able to meet safely face to face. Materials will be available for pick around the city.

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* 1. Please select the session you would like to enroll in this fall from the list below

Mondays September 28 - December 14, 2020 from 10:00 to 11:00 AM - Facilitator Mechna Sarath, Khmer Support

Tuesdays September 29 - December 15, 2020 from 10:00 to 11:00 AM - Facilitator Sokunthea Suy

Tuesday and Thursdays September 29 - December 17, 2020 from 10:00 to 11:00 AM - Facilitator Paula Tye-Flagler

Wednesdays September 30 - December 16, 2020 from 10:00 to 11:00 AM - Facilitator Madeline Britto Spanish Support

Fridays October 2 - December 18, 2020 from 10:00 to 11:00 AM - Facilitator Elisabeth Tiru Spanish support

Fridays October 2 - December 18, 2020 from 10:00 to 11:00 AM Facilitator Madeline Britto

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* 2. Please list names of children participating

Child 1

Child 2

Child 3

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* 3. Please list birthdates of children list above

Birth date child 1

Birth date child 3

Birth date child 2

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* 4. Parent/Guardian Contact information

Name

Apartment or street number

Street

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

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* 5. Language Spoken at home

English

Spanish

Portuguese

Khmer

Other (please specify)

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* 6. Are you interested in participating in parenting groups?

Yes

If yes, what topics are you interested in exploring

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* 7. Are you interested in participating on our Coordinated Family and Community Engagement Parent Advisory Council which meets 3 to 4 time per year?

Yes

Maybe

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* 8. Please share your ideas for ways our Coordinated Family and Community Engagement Grant can support you in your role as your child's first teacher.