Building Healthy Families, Inc.

Thank you for your interest in BrightStart For Families! The next BrightStart is scheduled to begin Saturday, March 16, 2024 and will be held at our facility at 20 Hartford Road in Manchester.
If you are expecting a baby or have at least one child from birth through four years old, and have not previously attended BrightStart you are eligible to attend. We do our best to accept every family, but space is limited by the number and ages of children we can serve.
This application form is to gather the contact information of adult participants (parents, caregivers, grandparents). We will let you know if you and your child will be able to attend in person. We will email you to confirm your attendance. An email address is necessary for each parent/caregiver to access our online BrightStart sessions.

We also need the dates of birth and first names/nicknames of enrolled children to create our Children's BrightStart Learn and Grow Program.

We are looking forward to a great experience!

* indicates required

Your First (Given) Name *

Name/Nickname of less than 9 letters

Your Last (Family) Name

Your Email Address *

Your Cell Phone Number *

( ) -

Your Home Address

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

Do you receive text messages? *

Yes
No

Are both parents planning to attend? *

Yes
No

Other Parent's First (Given) Name

Please provide First Name/Nickname of less than 9 letters

Other Parent's Last (Family) Name

Oher Parent's Email

We send weekly updates via to all participants.

How many children will you bring to BrightStart? *

None. We're expecting.
One
Two
Three or more (see below)

If you plan to bring 3 or more children, we'll call you for details.

First or Nickname of your youngest child attending

Name/Nickname of less than 9 letters

Youngest Child's Birth Date

We use birth dates to arrange children's classes.

First or Nickname of next older child attending

Name/Nickname of less than 9 letters

Next Older Child's Birth Date

We use birth dates to arrange children's classes.

Names and Birth Dates of Other Children

Tell us the first names & birth dates of other children attending

Does your family participate in WIC? *

Yes
No

Please share how we can best serve your family.

Do you have any particular needs or purposes in attending BrightStart? Any allergies, special needs, or other concerns?

Dietary Restrictions/Allergies

Please tell us about any dietary restrictions you or your child have.

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