FOCS Registration

1
Register for a FOCS group, workshop, or event* This field is required.Below is what we are currently accepting registration for:
Seattle Parent of BIPOC Newborns (birth to 6 months) - Feb. 17 - April 7
Seattle Parents of BIPOC Waddlers (6 months through 3 years) - Feb. 15 - April 12
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
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
4
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
5
First Name* This field is required.Please enter this information for the first parent/caregiver who will be attending.
6
Last Name* This field is required.Please enter this information for the first parent/caregiver who will be attending.
7
Email* This field is required.Please enter this information for the first parent/caregiver who will be attending.
example@example.com
8
Phone Number* This field is required.Please enter this information for the first parent/caregiver who will be attending.
Include area code
9
Year of Birth* This field is required.Please enter this information for the first parent/caregiver who will be attending.
10
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
11
Race(s) (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
Other
12
Gender (select all that apply)* This field is required.Please enter this information for the first parent/caregiver who will be attending.
Cisgender (not transgender)
Two-Spirit
Transgender
Fa’afafine
Female
Fa’afatama
Male
Agender
Non-Binary
Other
13
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.
Yes, a second parent/caregiver will be attending
No
14
First Name of Second Parent/Caregiver* This field is required.Please enter this information for the second parent/caregiver who will be attending.
15
Last Name of Second Parent/Caregiver* This field is required.Please enter this information for the second parent/caregiver who will be attending.
16
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
17
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
18
Year of Birth of Second Parent/Caregiver* This field is required.Please enter this information for the second parent/caregiver who will be attending.
19
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
20
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
Other
21
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.
Cisgender (not transgender)
Two-Spirit
Transgender
Fa’afafine
Female
Fa’afatama
Male
Agender
Non-Binary
Other
22
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
23
First Child Attending - First and Last Name* This field is required.
24
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
25
First Child Attending - Date of Birth or Estimated Due Date* This field is required.
Date
Month
Day
Year
26
First Child Attending - Latino/a/x/e Ethnicity?* 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
Yes
No
Prefer Not to Answer
Unknown
27
First Child Attending - Race(s) (select all that apply)* This field is required.
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
Other
28
First Child Attending - Gender (select all that apply)* This field is required.
Transgender
Two-Spirit
Cisgender (not transgender)
Fa’afafine
Female
Fa’afatama
Male
Agender
Non-Binary
Prefer not to say
Unknown
Other
29
Second Child Attending -First and Last Name* This field is required.
30
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
31
Second Child Attending - Date of Birth or Estimated Due Date* This field is required.
Date
Month
Day
Year
32
Second Child Attending - Latino/a/x/e Ethnicity?* 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 the information of the second parent/caregiver participating in group meetings.
Yes
No
Prefer Not to Answer
Unknown
33
Second Child Attending - Race(s) (select all that apply)* This field is required.
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
Other
34
Second Child Attending - Gender (select all that apply)* This field is required.
Transgender
Two-Spirit
Cisgender (not transgender)
Fa’afafine
Female
Fa’afatama
Male
Agender
Non-Binary
Prefer not to say
Unknown
Other
35
Third Child Attending - First and Last Name* This field is required.
36
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
37
Third Child Attending - Date of Birth or Estimated Due Date* This field is required.Child 3
Date
Month
Day
Year
38
Third Child Attending - Latino/a/x/e Ethnicity?* 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
Yes
No
Prefer Not to Answer
Unknown
39
Third Child Attending - Race(s) (select all that apply)* This field is required.
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
Other
40
Third Child Attending - Gender (select all that apply)* This field is required.
Transgender
Two-Spirit
Cisgender (not transgender)
Fa’afafine
Female
Fa’afatama
Male
Agender
Non-Binary
Prefer not to say
Unknown
Other
41
Fourth Child Attending - First and Last Name* This field is required.
42
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
43
Fourth Child Attending - Date of Birth or Estimated Due Date* This field is required.Child 4
Date
Month
Day
Year
44
Fourth Child Attending - Latino/a/x/e Ethnicity?* 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
Yes
No
Prefer Not to Answer
Unknown
45
Fourth Child Attending - Race(s) (select all that apply)* This field is required.
Asian/Asian-American
Black, African, or African American
Middle Eastern or North African
Indigenous to the Americas/American Indian/Alaska Native
Native Hawaiian/Pacific Islander
White/European
Other
46
Fourth Child Attending - Gender (select all that apply)* This field is required.
Transgender
Two-Spirit
Cisgender (not transgender)
Fa’afafine
Female
Fa’afatama
Male
Agender
Non-Binary
Prefer not to say
Unknown
Other
47
Fifth Child Attending - First and Last Name* This field is required.
48
Fifth Child Attending - Grade* This field is required.
High School
Middle School
Other or N/A
49
Fifth Child Attending - Date of Birth or Estimated Due Date* This field is required.
Date
Month
Day
Year
50
Fifth Child Attending - Latino/a/x/e Ethnicity?* 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
Yes
No
Prefer Not to Answer
Unknown
51
Fifth Child Attending - Race(s) (select all that apply)* This field is required.
Asian/Asian-American
Black, African, or African American
Middle Eastern or North African
Indigenous to the Americas/American Indian/Alaska Native
Native Hawaiian/Pacific Islander
White/European
Other
52
Fifth Child Attending - Gender (select all that apply)* This field is required.
Transgender
Two-Spirit
Cisgender (not transgender)
Fa’afafine
Female
Fa’afatama
Male
Agender
Non-Binary
Prefer not to say
Unknown
Other
53
Does anyone in your household who will be attending have any access needs? If so, please describe.
Huge
Large
Normal
Small
Ok
Ok
54
Potential Barriers to Program Participation (select all that apply)
Childcare
Transportation
Other
55
What language(s) would you like to receive services in?* This field is required.Select all that apply
English
Other
56
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
57
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
58
Number of People in Your Household* This field is required.
59
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
60
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.
61
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.
62
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
63
Please verify that you are human* This field is required.
Should be Empty: