Stay-N-Play Pilot - Phase 2  | Registration for January - March
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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?
 
Yes
 
No
 
 
 
Can your organization provide giveaway packages for the participants?  (i.e. gift cards, gift baskets, cleaning supplies, passes for family fun activities, etc.)
 
Yes
 
No
 
 
 
Is there anything not listed that your organization is willing to provide/support?