Can we connect you to the following services?
Please provide your information so providers can contact you about the services you are interested in. Promise Partnerships consist of multiple organizations that provide services in our community. By providing your contact information below, you consent to your contact information being shared with Partners who provide the services offered within the Promise Partnership. This allows them to contact you via phone, email, text or mail to tell you about their services.
Would you like help in applying for health coverage for you or your child?
Would you be interested in receiving information about medical care?
Do you need assistance finding health resources for you or your child? Would you like help filling out medical forms?
Would you like help obtaining FREE eye exams and glasses for your student?
Would you like help obtaining REDUCED FEE dental care for your student?
Would you be interested in receiving information about mental health services in our community?
If you answered yes to any of these questions, provide your contact information below, dial 211, or contact People’s Health Clinic at (435) 333-1850
Do you have questions about your immigration status in the United States? Would you like to attend a free Immigration Workshop in Park City?If yes, provide your contact information below or call Holy Cross Ministries at (801) 261-3496
Parent First and Last Name *
Your answer
Student First and Last Name *
Your answer
Email Address
Your answer
Primary Phone *
Your answer
What is the best way to contact you?
Where did you receive this form?(i.e. Trailside Elementary, Treasure Mountain Junior High or The Christian Center of Park City…)
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