St. Charles School District Parents As Teachers Online Enrollment Form
Thank you for your interest in Parents as Teachers! Please enter the required information in the form below and then submit to register.
Email *
Family Information
Family Name *
Custodial Parent's Last Name
Primary Caregiver's Name *
Primary person responsible for working with Parents as Teachers organization
Address *
Number, Street, City, State and Zip
Referral Source *
sending me a list to make drop down options
Are you interested in receiving just a developmental screen or on-going services *
Best Time for Home Visits (evenings tend to have a waitlist quickly)
 *
Using the grid below, select what time of day for each day of the week you would usually be available to schedule Home Visits.  You must check at least one box for each day of the week but if more than one time slot works for a specific day, you can select more than one box for that day.

Example 1: If I (the parent) work Mondays from 5am-2pm and am free usually after that with my child at home, in the Monday row I would check the box under the "Evenings (4pm-6pm)" column to show that is a time I would potentially be available for Home Visits.  I would continue to mark what times would work for my family for the rest of the days of the week.

Example 2: If my work schedule is set that I always have Wednesdays off but I work from 8am-6pm on Monday, Tuesday, Thursday & Friday, I would check in the column for "No time on this day works for us" for the days I work and would check all 3 time slots as available for Wednesday.
Mornings (9am-12pm)
Afternoons (12pm-3pm)
Evenings (4pm-6pm)
No time on this day works for us
Mondays
Tuesdays
Wednesdays
Thursdays
Fridays
What are you hoping to get out of the program? *
Home School *
based on your address, which elementary school would your child attend
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