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Parkway Parents As Teachers Enrollment Form
Parents as Teachers (PAT) is a parent education program offered by the Parkway School District at no charge serving families who are expecting a child or have children under the age of kindergarten entry. Please complete this form so a program representative can contact you to begin the process. Thank You!
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* Indicates required question
Email
*
Your email
Parent/Guardian 1 Full Name (First Last)
*
Your answer
Parent 1 Phone (xxx-xxx-xxxx)
*
Your answer
Parent 1 Email
*
Your answer
Relationship to Child(ren) Enrolling
*
Mother
Father
Legal Guardian
Foster Parent
Other:
Ethnicity:
*
Hispanic
Non-Hispanic/Latino
Race (Check all that apply)
*
American Indian or Alaskan Native
Asian
Black or African American
Multi race/Other
Native Hawaiian or Other Pacific Islander
White
Required
Parent/Guardian 2 Name (First Last)
Your answer
Parent 2 Phone (xxx-xxx-xxxx)
Your answer
Parent 2 Email
Your answer
Parent 2 Relationship to Child(ren) Enrolling
Mother
Father
Legal Guardian
Foster Parent
Other:
Clear selection
Parent 2 Ethnicity:
Hispanic
Non-Hispanic/Latino
Clear selection
Parent 2 Race (Check all that apply)
American Indian or Alaskan Native
Asian
Black or African American
Multi race/Other
Native Hawaiian or Other Pacific Islander
White
Home Address (xxx Street, City, Zip)
*
Your answer
Marital Status
*
Your answer
Parkway Elementary School of Attendance (if known)
*
Choose
Barretts
Bellerive
Carman Trails
Claymont
Craig
Green Trails
Hanna Woods
Henry
Highcroft Ridge
Mason Ridge
McKelvey
Oak Brook
Pierremont
River Bend
Ross
Shenandoah Valley
Sorrento Springs
Wren Hollow
Unknown; please contact me
Have you previously been enrolled in Parkway Parents as Teachers?
*
Yes
No
Languages spoken in the home:
*
Your answer
Child's Legal Name (First, Middle, Last)
*
Your answer
Child's Gender
*
Your answer
Child's Birthday
*
MM
/
DD
/
YYYY
Child's Ethnicity:
*
Hispanic
Non-Hispanic/Latino
Child's Race (Check all that apply)
*
American Indian or Alaskan Native
Asian
Black or African American
Multi race/Other
Native Hawaiian or Other Pacific Islander
White
Required
Second Child's Legal Name (First, Middle, Last)
Your answer
Second Child's Gender
Your answer
Second Child's Birthday
MM
/
DD
/
YYYY
Second Child's Ethnicity
Hispanic
Non-Hispanic/Latino
Clear selection
Second Child's Race (Check all that apply)
American Indian or Alaskan Native
Asian
Black or African American
Multi race/Other
Native Hawaiian or Other Pacific Islander
White
Do you have any concerns about your child?
Your answer
Personal Visits are offered weekdays between 8:00 am and 3:30 pm. Families not available during these times may be temporarily added to a waitlist until an educator has early morning/evening availability.
*
With notice, our family can schedule visits to start between 8:00 am and 3:30 pm Monday - Friday
Our family requires visits Monday - Thursday after 4:00 pm.
Our family requires visits Monday - Friday before 8:00 am.
Required
If you anticipate your availability will change soon (maternity leave, job change, teacher on break, etc.), please indicate it here.
Your answer
Please describe SPECIFIC days and time preferences (Monday-Friday) that you are available for home visits. Visits are generally scheduled one month in advance. Please note at least one Parent/Legal Guardian MUST be present and participate during the visit.
Your answer
How did you learn about Parents As Teachers?
Your answer
Thank you for your response! We will be in contact soon!
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