Fair Grove PAT Sign up Form
Parents as Teachers promotes the optimal early development, learning and health of children (prenatal to kindergarten entry) by supporting and engaging their parents and caregivers. These supports are successful through personal visits based on your child’s age and needs along with a yearly developmental screening and management of meeting developmental milestones. 
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Email *
Child's First Name *
Child's Last Name *
Child's Birthday *
MM
/
DD
/
YYYY
Parent/Guardian's First Name *
Parent/Guardian's Last Name *
Parent/Guardian's Relation to Child *
Address of Parent/Guardian named above (Street Address, City, State and ZIP) *
Parent/Guardian Phone # (include area code) *
Parent/Guardian Alternative Phone # (include area code)
What time of day would you prefer a PAT visit?
 *
Other information we may need to know about your child.
A copy of your responses will be emailed to the address you provided.
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