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Jo Daviess Free 8 Week Preschool Family Interest Form

Family Information
Do you live in or are you connected to Jo Daviess County?
Child Information
Is your child currently in preschool, childcare, Head Start, or another early learning program?
Yes
No
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
No
Mostly, but we may have a conflict
Can you attend the first Zoom call on Tuesday, October 6, 2026 at 6:00 PM?
Yes
No
Can you attend the closing Zoom call on Wednesday, December 16, 2026 at 6:00 PM?
Yes
No
Other
Do you have internet access and access to a phone, tablet, or computer to watch weekly videos?
Yes
No
I may need support with access
Are you willing to complete a short pre-program and post-program survey?
Yes
No
Other
Are you willing to complete simple weekly activities at home with your child?
Yes
No
Unsure
Other Information
I give Mindful Minutes permission to contact me about this program.
Yes
No
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