Family Workshop Registration

November Workshop: Family Connections Services

Por favor utilize el menú desplegable de arriba para seleccionar el lenguaje para este formulario. // Please use the drop down menu above to select a language for this form.
Join us to learn more about our services, including:
- Triple P (Positive Parenting Program), Home Visiting, and Mental Health services
- The benefits of these services
- How to enroll
This virtual workshop will be on Zoom on Tuesday, November 5, 2024, from 6:00 PM to 7:00 PM.
Name*

First NameLast Name
Email*
example@example.com
I will attend the following session:

Tuesday
Are you currently enrolled in a Family Connections class?*

YesNo
Would you like more information about the programs and resources available at Family Connections?

YesNo
Which class(es) are you or your child attending?*

Daly City - Nurturing AMDaly City - PreschoolRedwood City - Nurturing AMRedwood City - Nurturing PMRedwood City - PreschoolEast Palo Alto - Nurturing AMEast Palo Alto - PreschoolEast Palo Alto - Little Explorers
Are you a parent or caregiver of a child under the age of 6?*

YesNo
Language preference*

EnglishSpanish
What is your ethnicity? Please select all that apply.*

American Indian or Alaska NativeAsianBlack or African AmericanHispanic / Latino / LatinxPacific IslanderWhiteMulti-RacialChoose not to discloseOther
What is your total family annual income?*
Zip Code*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please list any additional parents or caregivers who will participate in this workshop with you.
Which workshop:
Should be Empty:

November Workshop: Family Connections Services