Register your Interest in the Calaveras County Home Visiting Program
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  • Register your Interest in the Calaveras County Home Visiting Program

    Calaveras County Public Health

  • Welcome to the Calaveras County Home Visiting Program!

    We're here to support you and your child's journey. Our free program offers:

    • Information about your child's development
    • Tips and tools for parenting
    • Connections to local resources and services
    • Regular visits with a trained family support specialist

    This questionnaire helps us understand how we can best serve your family. It takes about 2-3 minutes to complete. All responses will be kept secret. We will not sell or give away any information given to us using this form.

  • Do you live in Calaveras County?

  • Our home visiting program is only open to community members of Calaveras County. Thank you for your interest.

  • Which of the following describe you? (check all that apply)

  • Our home visiting program only serves parents (including biological, adoptive, foster, or legal guardians) or expecting parents.

    Thank you for your interest.

  • What stage of pregnancy are you or your partner in?*

  • Our home visiting program serves children from birth to age 6. For children over 6, please visit our website to learn about available services and support programs for school-age children.

    Thank you for your interest.

  • Which stressors or challenges in your life make parenting more difficult at times? (Select all that apply)

  • Our home visiting program is only open to caregivers/parents who are experiencing some kind of stressor or challenge in parenting.

    Thank you for your interest.


  • Note: if you are a parent, then you are the "caregiver".

  • Format: (000) 000-0000.
  • 7. How do you prefer to be contacted by us?*
  • 8. What is your preferred language for communication with our program?*
  • 9. What is your relationship to the child? (Select the option that best describes your current legal and caregiving role)*
  • 10. Are there any health-related accommodation or support needs we should be aware of for your child?*

  • Examples: allergy precautions, mobility support, developmental support, seizure protocols, sensory considerations, communication support.

  • 11. Does your household currently receive any of the following benefits? (Check all that apply)*
  • 12. What is your household's annual income?*
  • 14. How did you hear about the Calaveras Home Visiting Program?
  • Should be Empty: