Booking an appointment with Waterloo Region Family Network Family Resource Coach (2026)

Booking an appointment with Waterloo Region Family Network Family Resource Coach

(Thank you for your interest in booking an appointment with Waterloo Region Family Network Family Resource Coach. The information that you share below will be shared with the Waterloo Region Family Network and will also be visible to the EarlyON professionals supporting our booking process. We treat all confidential information with the utmost respect and your information will not be shared beyond with those professionals who require it to support your family and your appointment.)
The appointment must be made and attended by a family member of the child. Please complete the form below and a team member will connect with you to confirm your appointment.
1. Adult Name*

First NameLast Name
2. Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
3. Email*
example@example.com
4. Child Name*

First NameLast Name
5. Child's Date of Birth*

MonthDayYear
6. I am a family member of the child and will attend the appointment.*

YesNo
If you answered "no" to the above question, you cannot book this screening appointment. You must be a family member of the child listed in question 4 above.
7. What concerns do you have that you are hoping to talk with the Waterloo Region Family Network Family Resource Coach?*
8. Is there anything else that you would like the Waterloo Region Family Network Family Resource Coach meeting with you to know about?
9. Which EarlyON location you would like to book to attend?*
10. Which date you would like to book? (Please choose one only)*
10. Which date you would like to book? (Please choose one only)*
10. Which date you would like to book? (Please choose one only)*
10. Which date you would like to book? (Please choose one only)*
10. Which date you would like to book? (Please choose one only)*
10. Which date you would like to book? (Please choose one only)*
11. EarlyON professionals are able to provide childminding for up to two children ages 18 months and up during your appointment if needed. Do you need childminding during your appointment?*

Yes, I require childminding during my appointmentNo, I will not be bringing my child(ren)No, I need to have my child(ren) attend the meeting with me. I acknowledge that this may impact the overall effectiveness of our discussion and could lead to the possibility of scheduling additional meetings.
If yes, please indicate the names and age(s) of the child(ren) requiring supervision.
Your appointment is 30 minutes long. Please be prompt and arrive on time. Thank you!
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