​​

Families with children birth to 36 months.
To finish your enrollment please complete the following form. This information is kept for statistical purposes. It is confidential and will not be used to discriminate services.

Questions? Email: Michelle Kelly
Phone: (913)624-2800

Items denoted with a red asterisk * are required.

Parents As Teachers Enrollment

Parent Information
 
 
 
 




Other Information





Additional Parent Information
 
 
 
 




Child Information









Please Answer All 3 questions







Sibling Information


Additional Sibling Information


Program Information


If yes:

Blue Valley Parents as Teachers informs, supports and encourages you in your parenting role. Our services are designed to help you learn more about parenting and your child's development, help you cope with the challenges of family life, and help identify and address any potential delays in your child's development. Together, you and the parent educator will focus on ways you can interact with your child to support his or her development, work through your parenting questions and concerns, and build a healthy environment for your child.

Routine information will be collected during your participation in the program. Parent educators are 'mandated reporters'. This means that by laws they must make a report to protect your family's safety if there are concerns about child abuse or neglect, domestic violence, elder abuse, or intent to harm self or others. With exception of this type of information, all your information will be kept confidential and will not be released outside the program without your written permission or a court order.

Your parent educator agrees to:
  • Schedule a minimum of ten home visits a year at a convenient time for parents and parent educator.
  • Provide research based developmental information and evidence based parenting practices.
  • Invite your family to group connections throughout the year.
  • Offer annual screenings (development, health, hearing and vision).
  • Connect your family to resources as needed or requested.
  • Help you set and work on your family goals.
Your family agrees to:
  • Actively engage with your child and parent educator in a minimum of ten home visits this year.
  • Attend a minimum of one group connection or playgroup this year.
  • Minimize distractions during the personal visit (television, phones, pets, etc.)
  • Set period family/child goals.
  • Provide feedback to the program by completing the annual satisfaction survey.
The limits of our services:
Parent educators are not psychologists or medical professionals. We do not diagnose developmental, psychological, or medical conditions. However, we can help you connect to qualified professionals and resources that can assist in these situations.

*Agreement
I understand that at any time, I can let my parent educator or the coordinator know that I no longer want to participate.

If you do not receive a follow up email from Parents as Teachers regarding this enrollment in the next two weeks please call (913) 624-2800.