Stay-N-Play Pilot - Phase 2  | Registration for January - March
Questions marked with a * are required Exit Survey
Main Point of Contact : 
* Full Name : 
* Organization : 
* Phone : 
* Email Address : 
Please Identify location preferences for providing playgroups facilitation
The Grove at Keith Creek
Fairgrounds Valley
Both Locations
Either Location
Please Indicate any additional scheduling preferences 
Is your organization providing a similar programs within Rockford? If yes, please describe:
Can your organization sponsor snacks and refreshments for the playgroups?
Can your organization provide giveaway packages for the participants?  (i.e. gift cards, gift baskets, cleaning supplies, passes for family fun activities, etc.)
Is there anything not listed that your organization is willing to provide/support?