FOCS Registration

1
Which parent group are you registering for?* This field is required.
Seattle Parents of BIPOC Newborns - Starting April 18, 2026
Snohomish County Parents of BIPOC Toddlers - in Mountlake Terrace Starting April 19, 2026
2
Address* This field is required.Please enter your family's address.
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
3
Your First Name* This field is required.Please enter this information for the first parent/caregiver who will be attending.
4
Your Last Name* This field is required.Please enter this information for the first parent/caregiver who will be attending.
5
Your Email* This field is required.Please enter this information for the first parent/caregiver who will be attending.
example@example.com
6
Your Phone Number* This field is required.Please enter this information for the first parent/caregiver who will be attending.
Include area code
7
Latino/a/x/e Ethnicity* This field is required.Note - Since Latino/a/x/e is an ethnicity that can be of any race, we ask this question separately from race https://www.census.gov/topics/population/race/about.html Please enter this information for the first parent/caregiver who will be attending.
Yes
No
Prefer Not to Answer
Unknown
8
Your Races and Ethnicities (select all that apply)* This field is required.Please enter this information for the first parent/caregiver who will be attending.
Asian/Asian-American
Black, African, or African American
Indigenous to the Americas/American Indian/Alaska Native
Middle Eastern or North African
Native Hawaiian/Pacific Islander
White/European
Latina/o/x/e
Other
9
Your Gender (select all that apply)* This field is required.Please enter this information for the first parent/caregiver who will be attending.
Transgender (doesn't identify as gender assigned at birth)
Cisgender (does identify as gender assigned at birth)
Female
Male
Non-Binary
Agender
Two-Spirit
Fa’afafine
Fa’afatama
Questioning or unsure
Prefer not to say
Unkown
Other
10
Your Year of Birth* This field is required.Please enter this information for the first parent/caregiver who will be attending.
11
Will another parent/caregiver be attending?* This field is required.Note: If more than two parents/caregivers will attending, please email us at info@focseattle.org so we can collect their information.
No
Yes, one additional parent/caregiver will be attending
Yes, more than one additional parent/caregiver will be attending
12
First Name of Second Parent/Caregiver* This field is required.Please enter this information for the second parent/caregiver who will be attending.
13
Last Name of Second Parent/Caregiver* This field is required.Please enter this information for the second parent/caregiver who will be attending.
14
Email of Second Parent/Caregiver* This field is required.Please enter this information for the second parent/caregiver who will be attending.
example@example.com
15
Phone Number of Second Parent/Caregiver* This field is required.Please enter this information for the second parent/caregiver who will be attending.
Include area code
16
Does second parent/caregiver identify as Latino/a/x/e?* This field is required.Note - Since Latino/a/x/e can be of any race, we ask this question separately from race https://www.census.gov/topics/population/race/about.html Please enter this information for the second parent/caregiver who will be attending.
Yes
No
Prefer Not to Answer
Unknown
17
Race(s) of second parent/caregiver (select all that apply)* This field is required.Please enter this information for the second parent/caregiver who will be attending.
Asian/Asian-American
Black, African, or African American
Indigenous to the Americas/American Indian/Alaska Native
Middle Eastern or North African
Native Hawaiian/Pacific Islander
White/European
Latina/o/x/e
Other
18
Gender of Second Parent/Caregiver (select all that apply) * This field is required.Please enter this information for the first parent/caregiver who will be attending.
Transgender (doesn't identify as gender assigned at birth)
Cisgender(does identify as gender assigned at birth)
Female
Male
Non-Binary
Agender
Two-Spirit
Fa’afafine
Fa’afatama
Questioning or unsure
Prefer not to say
Other
19
Year of Birth of Second Parent/Caregiver* This field is required.Please enter this information for the second parent/caregiver who will be attending.
20
For the additional parents/caregivers who will be attending: please provide their name, email address, phone number, relationship to the children, race & ethnicity information, gender information and year of birth.* This field is required.
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Ok
21
How many of your children will be attending?* This field is required.Please include any children you are currently expecting..
1
2
3
4
5
22
First Child Attending - First and Last Name* This field is required.
23
First Child Attending - Grade* This field is required.For example: Preschool, kindergarten, 1st grade, etc. If your child is not in school yet, write N/A
24
First Child Attending - Date of Birth or Estimated Due Date* This field is required.
Date
Month
Day
Year
25
Second Child Attending -First and Last Name* This field is required.
26
Second Child Attending - Grade* This field is required.For example: Preschool, kindergarten, 1st grade, etc. If your child is not in school yet, write N/A
27
Second Child Attending - Date of Birth or Estimated Due Date* This field is required.
Date
Month
Day
Year
28
Third Child Attending - First and Last Name* This field is required.
29
Third Child Attending - Grade* This field is required.For example: Preschool, kindergarten, 1st grade, etc. If your child is not in school yet, write N/A
30
Third Child Attending - Date of Birth or Estimated Due Date* This field is required.Child 3
Date
Month
Day
Year
31
Fourth Child Attending - First and Last Name* This field is required.
32
Fourth Child Attending - Grade* This field is required.For example: Preschool, kindergarten, 1st grade, etc. If your child is not in school yet, write N/A
33
Fourth Child Attending - Date of Birth or Estimated Due Date* This field is required.Child 4
Date
Month
Day
Year
34
Fifth Child Attending - First and Last Name* This field is required.
35
Fifth Child Attending - Grade* This field is required.
High School
Middle School
Other or N/A
36
Fifth Child Attending - Date of Birth or Estimated Due Date* This field is required.
Date
Month
Day
Year
37
Does anyone who will be attending have any food allergies or dietary restrictions or needs? If so, please describe.* This field is required.
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Large
Normal
Small
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Ok
38
Does anyone in your household who will be attending have any access needs? If so, please describe.* This field is required.
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Small
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Ok
39
Potential Barriers to Program Participation (select all that apply)
Childcare
Transportation
Other
40
Number of family members 0-17 years old?* This field is required.
41
Number of family members 18-24 years old?* This field is required.
42
Your Zip Code* This field is required.
43
Does anyone in your family (select all that apply):* This field is required.
Live in Seattle
Work in Seattle
Go to school in Seattle
No one in our family lives, works, or goes to school in Seattle
44
What language(s) would you like to receive services in?* This field is required.Select all that apply
English
Other
45
What language(s) does your family speak at home? (select all that apply)* This field is required.
English
አማርኛ/Amharic
ភាសាខ្មែរ / Khmer
Af-Soomaali / Somali
American Sign Language
Anishinaabemowin / Anishinaabe
Chahta' / Choctaw
Diné Bizaad / Navajo
dxʷləšucid / Lushootseed
Español / Spanish
Filipino
French
Gagana faʻa Sāmoa / Samoan
Lakȟótiyapi / Lakota
Lingala
Łingít / Tlingit
língua portuguesa / Portuguese
Ōlelo Hawaiʻi / Hawaiian
Sahaptin / Yakima
Siksikáí'powahsin / Blackfoot
Tiếng Việt / Vietnamese
vosa vaka-Viti / Fijian
xʷləmi tʃɔsən / Lummi
हिन्दी / Hindi
한국인 / Korean
廣東話 / Cantonese Chinese
普通话 / Mandarin Chinese
Other
46
Household Income* This field is required.This helps us advocate to funders to fully fund our parent support groups!
$20,000 or less
$20,000 - $40,000
$40,000 - $60,000
$60,000 - $100,000
$100,000 - $200,000
Over $200,000
47
Number of People in Your Household* This field is required.
48
How did you find FOCS (select all that apply):* This field is required.
I am a returning FOCS participant
Paper flyer
Word of mouth
Another organization
Social media
Healthcare worker
Google search
Other
49
Undoing Racism / White Privilege Agreement* This field is required.FOCS holds space for discussion on race, identity, community, and equity with a foundation of undoing systems of oppression. Our programs are not a way to check a diversity box or to debate racism. Racism and white privilege exist. FOCS community is a place where BIPOC families come to feel safer. We center the narratives of BIPOC people and those most impacted by oppression. We believe in upholding our value of undoing racism. These are our experiences, and we are sharing the pain, trauma, and liberation of them so we can be equipped with tools to protect and inform our BIPOC children
50
Data Use Agreement* This field is required.FOCS reports some demographic data and outcomes to our grantors and in our annual reports for the purposes of program evaluation, accountability, and to increase the likelihood of renewed funding. FOCS reports aggregated data only and will never disclose any personal or identifying data without gaining additional written consent.
51
Would you like to get email updates from FOCS?* This field is required.Select 'yes' to subscribe to our monthly newsletter
Yes!
No, thank you.
52
Would you like to receive reminder texts for the programming you are registering for?* This field is required.Select 'yes' to subscribe to our monthly newsletter
Yes!
No, thank you.
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