Parents as Teachers and Preschool Interest Form
Our Early Childhood program consists of various services for students starting prenatal- age 5. If you are interested in more information about our programs please fill out this form. Your information will be sent to our staff and we will be in touch soon. For more information or questions, please feel free to call our office at 417-221-7804 or email Regina Gohr @ gohrr@cleverbluejays.org
Don't forget to follow our Facebook page! https://www.facebook.com/cleverparentsasteachers

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Email *
Parent/Guardian's Name (Person Filling Out Form) *
Address *
Phone Number *
Email Address: *
Child #1 Name *
Child #1 Birth date *
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Child #2 Name
Child #2 Birth date
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DD
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YYYY
Child #3 Name
Child #3 Birth date
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Other children (Name, birthdate)
Availability for visits (choose all that apply) *
Required

Please let us know of any additional information for visit scheduling and availability.  

 *
How did you hear about Parents as Teachers? *
Please list any special needs or special services your child(ren) currently receives which you would like us to be aware of.
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