Learning Communities Interest Form

Parent or caregiver name

Relationship to the childRelationship to the childmotherfatherfoster parentgrandparentcaregiverteachertherapistother caregiver

Email address

Phone number

Children’s ages (optional)

Preferred group formatPreferred group formatlive online discussionexpert-led presentation with questionsstructured peer supporta combination

Preferred meeting frequencyPreferred meeting frequencyweeklytwice monthlymonthlyoccasional topic-based sessions

Preferred daysPreferred daysMTWThF

Preferred timesPreferred timesdaytimeevening

Topics of interestTopics of interestChild development and developmental milestonesStrengthening the parent-child relationship and attachmentCommunication and language developmentPlay and social skillsReading, writing, and school successBehavior support, routines, and positive disciplineSocial-emotional regulation, resilience, and mental wellnessFeeding, sleeping, and toiletingSupporting a child with a disability or learning differenceSibling and family relationshipsNavigating school services, evaluations, and IEPsParent well-being, stress, and building communityAnother topic

Another topic

This form expresses interest only and does not enroll you in a program. Please do not include private medical, educational, or identifying records.

Designed by Elegant Themes | Powered by WordPress