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Nurturing Seeds to Grow Strong Families
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Spring 2024 Virtual Parent Cafe Series Registration
Event Address: A Zoom Link will be sent to you after you register
Questions? Contact: Mary Mikus,
mmikus@pattankop.net
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* Indicates required question
Email
*
Your email
First Name
*
Your answer
Last Name
*
Your answer
Email
*
Your answer
Full Mailing Address (including street name & number, city, state and zip code)
*
Your answer
What County do you live in?
*
Choose
Adams
Allegheny
Armstrong
Beaver
Bedford
Berks
Blair
Bradford
Bucks
Butler
Cambria
Cameron
Carbon
Centre
Chester
Clarion
Clearfield
Clinton
Columbia
Crawford
Cumberland
Dauphin
Delaware
Elk
Erie
Fayette
Forest
Franklin
Fulton
Greene
Huntingdon
Indiana
Jefferson
Juniata
Lackawanna
Lancaster
Lawrence
Lebanon
Lehigh
Luzerne
Lycoming
McKean
Mercer
Mifflin
Monroe
Montgomery
Montour
Northampton
Northumberland
Perry
Philadelphia
Pike
Potter
Schuylkill
Snyder
Somerset
Sullivan
Susquehanna
Tioga
Union
Venango
Warren
Washington
Wayne
Westmoreland
Wyoming
York
What is your Race?
*
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiin and Pacific Islander
White
Multiracial
I prefer not to answer
I am of Hispanic, Latino or Spanish origin, including Mexican, Mexican-American, Chicano, Puerto
Rican, or Cuban origin.
*
Yes
No
I prefer not to answer
How Old is Your Child Who Receives Early Intervention or Family Support/Home Visiting Services?
*
0-1year old
1-2 years old
2-3 years old
3-4 years old
4-5 years old
5-6 years old
Older than 6 years old
What Services Does Your Child/Family Receive?
*
Infant Toddler Early Intervention
Preschool Early Intervention
Family Supports/Home Visiting Program
Other (Please share specific info. below)
Required
If Other Above, Please Share More Information about the Services your Child/Family Receives here.
Your answer
Please Check the Parent Cafes you would like to Attend. You are welcome to attend 1, 2 or all 3 of the Cafes!
*
Thursday, March 21st, 6:00-8:00 pm
Friday, April 26th, 12:00-2:00 pm
Tuesday, May 14th, 6:00-8:00 pm
Required
Do you require any accommodations (ADA or other) to participate in the Parent Cafes? If so, please specify.
*
Yes
No
If Yes above, please specify the accommodations that you require.
Your answer
How did you hear about the Spring 2024 Virtual Parent Cafes?
*
Your answer
Do you have any additional questions about the Parent Cafes?
Your answer
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