The BrightStart™Parenting Workshop Application
This form is for parents or other caregivers who plan to attend the BrightStart Parenting Workshop.  All families expecting a baby or who have at least one child from birth through four years old are eligible to attend.  All applications received by September 23rd will be reviewed and you will be notified before September 28th.

We do our best to accept every family, but space is limited.  We are looking forward to a great workshop!
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Email *
Father's Name *
Last name first, include if attending (include name you would like on name tag in parenthesis if different)
Mother's Name *
Last name first, include if attending (include name you would like on name tag in parenthesis if different)
BrightStart is designed for a family to attend only once.  If you previously attended and want to attend again, please give us a brief explanation for us to consider your application.
Street Address *
Town *
Zip Code *
Phone (xxx) xxx-xxxx *
What is your email address? *
How many children will attend the workshop with you? *
Since we can only provide programming for children up to eight years old, only children eight or younger are eligible to attend.
What is the name and a due date or birth date any children under 18 months old?
What is the name and birth date of any children 2-3 years old?
What is the name and birth date of any children 4-8 years old?
What food allergies or dietary restrictions do any family members have? *
Meals are provided as part of the workshop.  We will be sure to have alternative meal choices.
Required
Are you a SNAP recipient? *
Required
Does your family qualify for the Child Nutrition Program? *
Required
Ethnicity origin (or Race): Please specify your ethnicity.
This information is not used to determine eligibility for the BrightStart Workshop.
How did you hear about the Workshop?  Why are you interested in attending BrightStart?   *
Where do you buy food for your family?  Please check all that apply.
Help us prepare the healthy eating part of the workshop!
Do you prefer to receive text messages?
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A copy of your responses will be emailed to the address you provided.
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