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Jo Daviess Preschool Program
- Jo Daviess Preschool Interest Form
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Jo Daviess Free 8 Week Preschool Family Interest Form

Family Information

First name*

Last name*

Email*

Do you live in or are you connected to Jo Daviess County?*

Yes, I live in Jo Daviess County

Yes, my child attends a program /school in Jo Daviess County

Yes, we are connected to Jo Daviess County in another way

If you are connected to Jo Daviess County but do not live there, please explain.*

What city or town do you live in?*

Child Information

Child's First Name*

Child's Age*

Is your child currently in preschool, childcare, Head Start, or another early learning program?*

Yes

Not yet, but we are preparing for preschool/kindergarten

Participation Commitment

Can your family participate in the full 8-week program from October 6 through December 16, 2026? *

Yes

Mostly, but we may have a conflict

Can you attend the first Zoom call on Tuesday, October 6, 2026 at 6:00 PM?

Yes

Can you attend the closing Zoom call on Wednesday, December 16, 2026 at 6:00 PM?

Yes

Other

Do you have internet access and access to a phone, tablet, or computer to watch weekly videos?*

Yes

I may need support with access

Are you willing to complete a short pre-program and post-program survey?

Yes

Other

Are you willing to complete simple weekly activities at home with your child?*

Yes

Unsure

What made you interested in this program?*

Other Information

Is there anything else you would like us to know about your child or family?*

How did you hear about this program?*

I understand that completing this interest form does not guarantee a spot in the program.

I give Mindful Minutes permission to contact me about this program.*

Yes

Email: info@mindfulmins.com

563.542.1168

Phone:Location:

Dubuque, IA

First name*

Last name

Email*

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