Parent Club Workshop Request

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Use the form below to submit your request to host a Parent Club workshop.

Please note that services are limited to Miami-Dade County.

Your Contact Information

Organization Name

First Name

Last Name

Phone Number

Your Workshop Request

Please answer the questions below to help us better determine how and if we can accommodate your request.

Estimated Workshop Attendees:

Purpose for hosting the workshop or desired outcome:

Will the workshop be open to the general public?

Yes No

Please provide the workshop delivery method

Proposed Workshop Date & Time:

Workshop Location Name:

Address

Street Name and Number:	Suite or No.
Street Name and Number:	Suite or No.

City, State, and Zip Code:

City	State:	Zip Code:
City	State:	Zip Code:

How many parking spaces are available at the proposed location?

Are restrooms available at the workshop location?

Yes No

Is audiovisual equipment available on site? (select all that apply)

Your Workshop Attendees

Preferred Language:

English Spanish Creole

Childcare:

How many children ages 3 to 12 years old require childcare? If requested, a separate room must be available
How many children ages 3 to 12 years old require childcare? If requested, a separate room must be available

Childcare Contd':

What are the ages of the children requiring childcare?
What are the ages of the children requiring childcare? 3-6 years old 4-9 years old 10-12 years old

Special Accommodations:

Do you expect any attendees with a disability requiring special accommodations?
Do you expect any attendees with a disability requiring special accommodations? Yes No

SPECIAL ACCOMMODATIONS CONT'D:

If yes, please describe the accommodation needed
If yes, please describe the accommodation needed

Additional Comments:

How did you hear about us?

Accessibility Statement

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Parent Club Workshop Request Grants My Profile

Accessibility Statement

Parent Club Workshop Request

Grants

My Profile