How many people are you a parent or caregiver for?
What ages are the people for whom you are a parent or caregiver? Check all that apply.
What are some parenting/caregiving topics on which you would appreciate educational talks or information? Check all that apply.
Which of the topics listed above (including ones you added) would you be willing to organize or help lead a casual "coffee club" type social/support group?
What types of social events would you be most interested in?  Check all that apply!
Please describe below how this group can be MOST helpful to you.
We want to make sure that the times of meetings or other events are convenient.  Please choose the times when you would be able to participate in a meeting or other event (meetings will not be longer than 1 hour). Check all that apply.
What is your gender?
Please provide us with your contact information so that we can keep you informed about meetings and events.
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