Family Registration

Thank you for your interest in attending today's Screening!! Please fill this registration form out to reserve your spot. 

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* 1. Contact information

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* 2. Including yourself, how many people will attend the event with you?
Incluyéndote a ti, ¿cuántas personas te acompañaron al screening?

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* 3. What are the ages of ALL of  the children in your household?
¿Cuáles son las edades de TODOS los niños de su hogar?

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* 4. How did you hear about today’s event? (Check all that apply.)
¿Cómo se enteró del evento de hoy? (Marque todo lo que corresponda.)

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* 5. Would you be interested in any of the following?
¿Estaría interesado en alguno de los siguientes?

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* 6. Are you a part of the Dual Generation Program?

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* 7. If you are a part of the Dual Generation Program, what partner agency do you work with? Please check all that apply:

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* 8. Are you currently in an education/workforce training or interested in enrolling in an education/ workforce training?
¿Está inscrito en una capacitación educativa/laboral o está interesado en inscribirse en una capacitación educativa/laboral?

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* 9. If you are interested in the Dual Generation program please indicate so here.  Dual Generation is for families that live in the following zip codes: 78202, 78203, 78205, 78207, 78208, 78210, 78215, 78218, 78219, 78220, 78222, 78227, 78237 that meet eligibility requirements, have a child(ren) ages 0-10 and want tuition assistance for a job training program, monthly support and access to resources such as quality childcare, financial empowerment, parenting classes, transportation assistance and more.

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* 10. Would you like to be added to the FREE Text Messaging Service Bright By Text? ​Bright by Text sends free activities, games, and resources right to your cell phone. Messages are targeted to your child’s age (0-18 Years) and include information on child development, language and early literacy, health and safety, behavioral tips, and more!/ Bright by Text le manda actividades, juegos, y recursos gratuitamente a tu celular.
Mensajes son dirigidos a la edad de tu niño e incluye información sobre el desarrollo de los jóvenes, lenguaje y alfabetismo, salud y seguridad, consejos para el comportamiento, y más!

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* 11. If you answered yes to sign up for Bright By text please add your cell phone number here./ Para inscribirse por favor de compartir su numero de celular. 

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* 12. If you answered yes to sign up for Bright By text please add the date of birth mm/dd/yy for your youngest child. / Para Insrbirse por favor de compartir la fecha de nacimiento de su nino/a mas chico.

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Thank you so much for your time.  We look forward to seeing you at the Carver Library for the screening!

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