Nurturing Seeds to Grow Strong Families- 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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Email *
First Name *
Last Name *
Email *
Full Mailing Address (including street name & number, city, state and zip code) *
What County do you live in?  *
What is your Race? *
I am of Hispanic, Latino or Spanish origin, including Mexican, Mexican-American, Chicano, Puerto
Rican, or Cuban origin.  
*
How Old is Your Child Who Receives Early Intervention or Family Support/Home Visiting Services?
*
What Services Does Your Child/Family Receive?  *
Required
If Other Above, Please Share More Information about the Services your Child/Family Receives here.
Please Check the Parent Cafes you would like to Attend. You are welcome to attend 1, 2 or all 3 of the Cafes! *
Required
Do you require any accommodations (ADA or other) to participate in the Parent Cafes?  If so, please specify.  
*
If Yes above, please specify the accommodations that you require.
How did you hear about the Spring 2024 Virtual Parent Cafes?  *
Do you have any additional questions about the Parent Cafes? 
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