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Contact Information for Fatherhood Program
Please complete the questions below if you would like to learn more about our upcoming Fatherhood group.
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First Name
*
Your answer
Last Name
Your answer
Are you a...
returning participant
new participant
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Does your child attend Head Start/Early Head Start? if so, please tell us which location:
Your answer
How did you hear about us?
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Email
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Phone Number
If you do not have your own number, please include the person's name of the phone number you're using.
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Address
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Which time(s) work best for you to meet each week?
Wednesdays, 5:30 pm to 7:30 pm
Other:
will you need childcare?
yes
no
Other:
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Is transportation a barrier for you?
yes
no
possibly
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Do you need an interpreter?- if yes what language?
Your answer
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