Butterfly Pavilion: 2022-2023 RMDS Toddler Program RSVP

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Welcome! The RMDS Toddler Program is for families with children birth through age three who are Deaf or Hard of Hearing. We are proud of the exemplary quality programs that we provide to families out in the community!

Our team is excited you will be joining us! Please RSVP by answering the questions below.

If you have questions or would like additional information, please contact Susie Broderick, RMDS Toddler Program Coordinator at sbroderick@rmds.co

Email *

Please RSVP by February 1st to receive materials and resources from the Toddler Program Team.

NAME OF PARENT, FAMILY MEMBER, GUARDIAN *

NAME OF CHILD *

CHILD'S BIRTHDATE (m/d/y) *

NAME/S AND AGE/S OF CHILD/REN ATTENDING

(Our Program is designed for Deaf/Hard of Hearing Children and their families. Siblings are welcome.)

PLEAE LIST YOUR CHILD'S PRIMARY MODE OF COMMUNICATION *

Communicates using American Sign Language

Communicates using Spoken Language

Communicates using a combination of Spoken Language and American Sign Language

Option 4

Other:

Required

COUNTY OF RESIDENCE *

CONTACT INFORMATION: Please list your email and phone number below. *

PHOTO RELEASE: Please indicate your preference below. *

YES, I authorize RMDS to use photos of me/my child for Toddler Program news and the Toddler Program RMDS website.

NO, I do not authorize RMDS to photograph or use photos of me/my child.

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Rocky Mountain Deaf School. Report Abuse

Forms