2013 -2024 Kids Morning Out Registration Form 
Please complete this registration for our Kids Morning Out (KMO) program.  Children will be placed in the order of form submission.  Once spots are full children will be added to a waitlist.  We are excited to welcome your family into our program!
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Email *
Child's First  and Last Name *
Child's Date of Birth (Birthdate for age-eligible children is between 8/1/2020 and 7/31/2021) *
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/
DD
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Gender *
Ethnicity *
Required
Mother's Name *
Mother's Email Address *
Mother's Cell Phone *
Father's Name *
Father's Email Address *
Father's Cell Phone *
What language/languages are spoken at home? What language does your child speak? *
Does your child have a medical condition
 Please describe any allergies your child has and possible reactions to exposure.  Please descriibe any other medical conditions.
Is your child enrolled in Parents as Teachers? *
If so, who is your Parent Educator?
Does your child currently receive any therapies, including First Steps services? If so, please describe. *
Do you have any special concerns or questions to which you would like to draw our attention?
Please indicate the location you would like to attend Kids Morning Out.  This form will be used as a waitlist for both sites. *
If my first preference of location is not available, I would be willing to register and attend at the other location. *
Please indicate how many days per week you would like your child to attend Kids Morning Out *
Please indicate your first preference of attendance days (Please choose up to three days) *
Required
Please indicate alternate attendance days - in the event that your first preference days are not available (Please choose up to two days) *
Required
A copy of your responses will be emailed to the address you provided.
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