Early Head Start Kalkaska Playgroup Registration
Please complete the following form to register for each playgroup you wish to attend.

This group meets at the Early Head Start classroom at 424 S. Cedar Street on the first and second Wednesday of the month from 10:30-12:00. Upcoming playgroup dates include: 


October 11 and 25
November 8 and 22
December 13 
January 10 and 24
February 14 and 28
March 13
April 10 and 24
May 8 and 22
June 12 and 26

Questions? 

Contact Carrie Norman 
231-633-0583

This playgroup is available at no charge to any parent with a child 0-5 in partnership with 5toONE  and the Early Head Start.
Sign in to Google to save your progress. Learn more
First Name: *
Last Name: *
Your relationship to the child(ren) attending: *
Required
Date of playgroup for which you are registering: *
MM
/
DD
/
YYYY
Is it your first time at a 5toONE playgroup today? *
Total number of people your party for this date's playgroup: *
Phone: *
Email Address: *
Confirm Email Address: *
Zip Code: *
County of Residence: *
School District: *
Would you be willing to help with a simple job (5-10 minutes) at this playgroup to help things run more smoothly? *
Captionless Image
If yes, which job?
Clear selection
Photo Release: *
Captionless Image
 Participating Child 1 Name: *
Participating Child 1 Birthdate: *
MM
/
DD
/
YYYY
Participating Child 2 Name:
Participating Child 2 Birthdate:
MM
/
DD
/
YYYY
Participating Child 3 Name:
Participating Child 3 Birthdate:
MM
/
DD
/
YYYY
Participating Child 4 Name:
Participating Child 4 Birthdate:
MM
/
DD
/
YYYY
Questions or additional information you wish to share?
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Northwest Education Services. Report Abuse
Google Forms