2022 - 2023 Siskiyou Parenting Education Program Online Registration.

If you have any questions, please call the First 5 Siskiyou Children and Families Commission Office at (530)918-7222

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* 1. If you are registering for a Parenting Series or Workshop, please select which one you are registering for:

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* 2. Participants Information

Full Legal Name (First/Middle/Last) *

Address

City/ Town *

State *

ZIP/Postal Code *

Email *

Phone Number *

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* 3. Would you like to receive, by e-mail, information about future trainings, activities, and events relating to parenting and professional development in our county?

Yes

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* 4. If you are an Approved Resource Parent or Resource Family Applicant, check the appropriate box

Approved Resource Parent (Foster Parent, Kinship Care Provider, etc.)

Resource Family Applicant (Interested Foster Parent, etc.)

N/A

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* 5. Please Check All That Describe You:

Adoptive parent with child under age 18

In the process of adoption of children under age 18

Birth Parent with children under age 18

Foster Parent

Community Member Interested in the Topic

Informal Relative/ Kinship Care Provider/ Non-Related Extended Family Member (ie. grandparents raising grandchildren)

State-funded preschool provider

Early Head Start/Head Start Center

Family Child care home provider

Other child care center provider

Provider of child care as needed for family, friend, or neighbor

Social Services or Child Welfare

County Probation Staff

Foster Family Agency Staff

Short Term Residential Therapeutic Program Staff (Previously Group Home)

Family Resource Center Staff/Volunteer/Board Member

Health Care Professional/ Administration

K-12+ administrator, teacher, staff

College administration, faculty, staff

County Probation Staff

Early Head Start or other home visitation program

Law Enforcement

Tribal Program

Student

County Supervisor/Special District/City Council Member

County/City Administration

Community-based Non-profit

CASA Volunteer

Behavioral/Mental Health

County or City Administration

County Board of Supervisor or City Council or Special District

Family or community advisory board

Community or Family Resource Center Board member, staff, or volunteer

Other nonprofit

Other (please specify)