New Parent boot camp

Father/Guardian Full Name*
Email*
Mother/Guardian Full Name*
Parent/Guardian Email*
Phone Number*

Area CodePhone Number
Text messageCall meEmail me
Please select the date to sign up Parent Boot Camp Class.
Each class has a min. of 15 families / maximum of 20 registered families. Parents must attend to receive gifts and enter to win grand prize.
The following are the requirments to be considered to received $100.00 toward your utility bill.

1. The individual must sign up online.

2. The individual must be present on the date of selection.

3. The individual must present a curently utility bill. One bill per household.

4. Families must submit their utility bill at the beginning of the event.

5. The five families will be randomly selected at the end of the event.
I acknowledge and understand all the requirements listed above. *
YesNo
Jefferson City DiapersWIC ProgramHealthy BlueCentral Missouri Community Action (CMCA)None of the above
First-time home buyingRent /Utility assistanceGED/Enrolling into collegeResources for children with special needsChild supportPre-martial, marriage and family counselingCredit repairNone of the above
How did you hear about us?*
Comments
Parent Boot Camp is sponsored by Jefferson City Diapers.

The Jefferson City Diapers inventory is supplied by donations from supporters across the Unites States, local community, sponsors, and partners. Thank you to our sponsors; private donors, Bibleway Community Church and Walmart!
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