EHS/HS Parent Contact Information

Child's Name *

First

Last

Please provide the name of the child regardless of whether they were previously enrolled.

Cell Phone *

(555) 555-5555

Home Phone

(555) 555-5555

Email *

How would you prefer to receive information from us? (check all that apply) *

Was your child an Early Head Start or Head Start student last year (2019-2020 school year)? *

Child's Age *

Please provide the child's age in years AND months (example: 3 years / 7 months)

Question, Comment or Message