Building Healthy Families, Inc.

This form is for parents or other caregivers who plan to attend the BrightStart Family 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 two weeks before the workshop will be reviewed and you will be notified before the workshop starts.

We do our best to accept every family, but space is limited by the number and ages of children we can serve. We are looking forward to a great workshop!

* indicates required

Email Address *

First Name ofEnrolling Parent or Caregiver's

Last Name of Enrolling Parent or Caregiver's

Parent's Phone Number

Do you receive text messages? *

Address *

Street Address Address Line 2 City State/Prov/Region Postal/Zip Country

Second Parent's Email Address (optional)

Is one of your children four or younger? *

Are you expecting a baby? *

If you are expecting, what is your due date?

How many children will you bring to the workshop? *

This section is to help us plan for the Learn and Grow for children

How did you hear about the Workshop?