First Time Parent Membership Registration

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• The First-Time Parent Membership is a free membership.
• This membership is limited to first-time parents with a child under 24 months who live in Winnebago County Illinois.
• Families may enroll 2 adults and qualifying infant(s). Adults can be parents, guardians,
caregivers, friends, or family members.
• All members must be named on the membership.
• Membership starts the day the family signs up and ends the month the child turns 24 months.

Email *

Primary Adult First Name *

Primary Adult Last Name *

Second Adult First Name

Second Adult Last Name

Child's First Name *

Child's Last Name *

Child's Date of Birth - Must on or before today's date. *

YYYY

Primary Adult Street Address *

City *

State *

Zip *

County of residence - This program is limited to new parents in Winnebago County and their child. *

Phone Number(s) *

How did you hear about the First Time Parent Membership Program? *

Send me a copy of my responses.

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This form was created inside of Discovery Center Museum of Rockford Inc.