Roadrunner Tots Registration Form - Red Bank Elementary School

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Please complete this registration form to participate in Roadrunner Tots (a 14-week family engagement preK program). This program is for the parent and child to participate together in weekly learning activities at the school that help build skills for preschool and beyond. There is no cost to participate. The spring session begins the week of January 29, 2024 and ends the week of May 9, 2024. Please note that space is limited.

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Adresse e-mail *

Child's first and last name *

Child's date of birth *

YYYY

Parent/Family Member/Caregiver first and last name *

Email contact *

Phone number (include area code) *

Home address *

Do you have concerns about your child's development? If yes, please explain. *

Yes

If you answered yes to the previous question, please explain your concerns.

Can you commit to participating in weekly family engagement sessions at the school and follow-up activities at home for the full 14 weeks (January 29, 2024 through May 6, 2024)? *

Yes

Maybe - I need more information before making a commitment.

Do you give permission for us to use your child's photo taken during our weekly sessions? (these may be posted in the school building, school newsletter, and/or school or district social media page to showcase our program) *

Yes, I give permission to use my child's photo as described above.

No, I do not give permission to use my child's photo as described above.

My child is really good at... *

My child needs help with... *

One thing I hope my child learns from this program is... *

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