Parents as Teachers Enrollment Form
Thank you for your interest in the Goddard Public Schools Parents as Teacher program. Please complete and submit this registration form to express your interest in joining our program. If you have any questions, please call (316) 794-4057 for more information.
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ईमेल पता *
Preferred Phone Number (must include area code) *
Mother/Guardian First Name and Last Name *
Mother/ Guardian Date of Birth *
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Father/Guardian First and Last Name
Father/Guardian Date of Birth
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Street Address, City and Zip Code *
Enrolling child #1 - Child's first, middle, and last name as it appears on birth certificate (middle name is required)

 *
Enrolling child #1 date of birth
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DD
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YYYY
Enrolling child #2 - Child's first, middle, and last name as it appears on birth certificate (middle name is required)

Enrolling child #2 date of birth
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DD
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YYYY
Please list name and age of any child/sibling living at home who will NOT be enrolling in the Parents as Teachers program
How did you hear about our Parents as Teachers Program? *
Parents as Teachers is a home visiting program. Are you interested in recieving home visits? *
Are you availible for daytime visits? *
Do you have any special conerns for you child? Please explain. *
Check all that apply: *
ज़रूरी
Marital Status *
Race (select one) *
Ethnicity (select one) *
What is the primary language spoken in your home? *
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