Judy Center Recruitment Survey

The Judy Center is an early childhood resource for families of children ages birth - 5 who live in the Indian Head, Dr. Mudd and Eva Turner school zones. We are funded through the Maryland State Department of Education. We are a FREE resource to your family! In order to determine if you are eligible for these free resources and programs, please answer the following questions. A Judy Center staff member will be in touch with you soon after receiving your responses.

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* 1. Please provide the following information:

Parent's Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

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* 2. Please provide the name and date of birth of all Judy Center aged children in your family (ages birth to Kindergarten age):

Name & DOB:

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* 3. What is your child's race or ethnicity?

Asian

Black or African American

Hispanic or Latino

American Indian

Native Hawaiian or other Pacific Islander

Two or more races

White

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* 4. Is your child enrolled in Head Start or Early Head Start?

Yes

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* 5. If your child is enrolled in childcare, please select from one of the following:

In home childcare

Childcare Center

None

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* 6. Is your child in the Infants and Toddlers program through Charles County Public Schools?

Yes