Resilient Futures Caregiver Registration
For group beginning January 5th, 2026
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Is another caregiver attending Resilient Futures?
*
Yes
No
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Mission Kids provides supervised childcare and dinner during group meeting times. To plan activities and meals accordingly, please answer the following to the best of your ability.
Do you require on-site childcare?
*
Yes
No
Child's Information
Child's Name
Age
Child's Information (2)
Child's Name
Age
Child's Information (3)
Child's Name
Age
Is there anything we should know about your child(ren) listed above?
While we understand that schedules can change, please indicate your agreement to participate in Resilient Futures for 5 weeks beginning Monday 1/5/26 from 5:30-7:00pm
Dates: 1/5, 1/12, (no session MLK day), 1/26, 2/2, 2/9
I confirm participation for the caregiver(s) listed above:
*
Yes
No
Thank you! We look forward to seeing you on January 5th. Please contact Kaylee (kmccormick@missionkidscac.org) with questions or concerns.
Submit
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