Community and In-Home Inquiry Form

Pacekids Programs Community and In-Home Inquiry Form

Child's Full Name

Child's Date of Birth

Child's School Name

Child's School Hours

Parent/Guardian Name

Phone

Address (Including city to confirm programming availability)

Timeslot(s) you and your child are available for programming (Pacekids offers programming Monday - Friday. For scheduling purposes, families must be available for programming 3- 4 days a week at the same time each day)

10:00am -12:00pm 1:00pm -3:00pm 4:00pm -6:00pm

Do you have an active FSCD agreement and caseworker

How did you hear about Pacekids?

Please read and confirm to complete your form

Thank you for your interest in Pacekids CIH Programs. Our CIH Coordinators will respond as soon as possible. If this is urgent, please call 403-234-7876.

Pacekids Programs Community and In-Home Inquiry Form

Contact and Location

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