Francis Howell School District Parents as Teachers Enrollment
Parents as Teachers is a FREE program for families with children (prenatal until Kindergarten entry).

If you have any questions or concerns, please call our office at 636-851-6060
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Email *
Person filling out this form is: *
1st Guardian's First Name *
1st Guardian's Last Name *
1st Guardian's work status *
Comments concerning availability for visits
1st Guardian's relationship to child *
Required
1st Guardian's Street Address *
1st Guardian's City *
1st Guardian's Zip Code *
1st Guardian's Phone Number *
1st Guardian's Preferred Method of Contact *
Required
1st Guardian's Ethnicity (click all that apply) *
Required
Primary Language Spoken in the Home (more than 50%) *
Adult(s) the child(ren) lives with? (click all that apply) *
Required
2nd Guardian's First Name
2nd Guardian's Last Name
2nd Guardian's work status
Clear selection
Comments concerning availability for visits
2nd Guardian's relationship to child
2nd Guardian's Email Address
2nd Guardian's Phone Number
2nd Guardian's Preferred Method of Contact
2nd Guardian's Ethnicity (click all that apply)
Check ALL days/times that you are available for visits.  Visits outside of 8 am to 4 pm are limited and may impact our ability to serve your family consistently during the program year.  This may also impact how soon we can schedule visits with your family. *
Before 8 am
8am to 2pm
2pm to 4 pm
After 4 pm
Monday
Tuesday
Wednesday
Thursday
Friday
1st Child's Legal Name (First) *
1st Child's Legal Name (Middle)
1st Child's Legal Name (Last) *
1st Child's Ethnicity (click all that apply) *
Required
1st Child's Birth Date *
MM
/
DD
/
YYYY
1st Child's Gender *
2nd Child's Legal Name (First)
2nd Child's Legal Name (Middle)
2nd Child's Legal Name (Last)
2nd Child's Ethnicity (click all that apply)
2nd Child's Birth Date
MM
/
DD
/
YYYY
2nd Child's Gender
Clear selection
3rd Child's Legal Name (First)
3rd Child's Legal Name (Middle)
3rd Child's Legal Name (Last)
3rd Child's Ethnicity (click all that apply)
3rd Child's Birth Date
MM
/
DD
/
YYYY
3rd Child's Gender
Clear selection
Do you have any specific area of need or concern?
Does your family receive supports from Social Service Agencies? *
If your family does receive supports from Social Service Agencies, please tell us which agencies.
What is your last year of school completed? *
Where did you learn about our programming?
Clear selection
Have you ever participated in Parents as Teachers before? *
If yes, where did you participate in PAT?
Comments:
A copy of your responses will be emailed to the address you provided.
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