Pre-register for STEP series (english)

Name of primary caregiver:*
First Last
Phone
Email*
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Please give the name and age of any child/children between the ages of 8 - 17 years who will participate in STEP with you:

Name	Age

Which of the following best describes you as a caregiver? (Click all that apply)*
- Biological Parent
- Foster Parent
- Adoptive Parent
- Kinship Caregiver
Will you need childcare for children under 8 years old?
- Yes
- No
Will you need assistance with transportation?
- Yes
- No

Will other supporting adults or caregivers attend with you? If YES please list names and relationship to you below:

Name	Relationship

Additional Information

All programs are offered at no cost and need your support to continue.