Give Your Child a Head Start! La Casa de Don Pedro's Head Start, Early Head Start, and Preschool Interest Form Please provide us with your contact information. Someone will reach out to you to discuss enrollment in our Early Head Start, Head Start, or Preschool Programs. OK Question Title * 1. Name of Child OK Question Title * 2. Child's Date of Birth Date / Time Date OK Question Title * 3. Please provide your contact information. Name Address Address 2 City/Town State/Province ZIP/Postal Code Email Address Phone Number OK Question Title * 4. Are there any other ways La Casa de Don Pedro can help you? We will have someone reach out to you to see how we can assist. After school enrichment or summer programs for school age children Adult education or English language programs Immigration assistance Family or youth counseling programs Utility assistance, energy conservation or removal of lead from your home Health related services Other (please specify) OK DONE