Care and Connect Sign Up Form / Referral
Who are you?
Choose
Teacher
Parent
Student
Other
Name:
Your answer
Phone Number:
Your answer
Email Address:
Your answer
Type of Care and Connect Needed:
Reading
Math
Science
Social Studies
Attendance
Technology
Household Needs
Mental Health
Other
Please Select a Time Preference:
8:00 - 8:30
8:30 - 9:00
9:00 - 9:30
9:30 - 10:00
10:00 - 10:30
2:00 - 2:30
2:30 - 3:00
3:00 - 3:30
Submit
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