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About LRCS
Apply for Services
LRCS Board of Directors
Legislative Advocacy
From Advocacy to Action
Family Support Council
Resources & Funding for Families
Service Delivery
Services for Children
Family-Centered Early Supports and Services
Children’s In Home Supports
School to Community-Based Transition Services
Services for Adults
Employment Services
Self Directed Services
Shared Family Living
Elder Services
Case Management
Resource Coordination
Family Resource Center
Family-Centered Early Supports and Services
Parent Education
Parent Ed Registration
Helpful Links
Step Ahead
Family Socialization Programs
Welcome Baby!
Giggles and Grins
Happy Sounds
Kinship Navigation Program
Donate
Giving
Ways to Give
Lifetime Business Partners
Fundraisers & Special Events
LRCS Foundation
Careers
President and CEO Search
Current Openings
Direct Support – Meet our Team!
Employment Benefits
Family Info Form Playgroups/Events
Family Info Form Playgroups/Events
Name of Activity
*
Giggles & Grins Playgroup
Happy Sounds Music Group
Traveling Playgroup
Family Event (movie night, fishing, etc.)
Parent/Caregiver Name
*
First
Last
Parent Date of Birth
*
MM slash DD slash YYYY
Additional Parent/Caregiver Name (Optional)
First
Last
Additional Parent Date of Birth
MM slash DD slash YYYY
Email
*
Contact Phone (Optional)
Residence
*
City
Child #1 Name
*
First
Last
Child #1 Date of Birth
*
MM slash DD slash YYYY
Child #2 Name
First
Last
Child #2 Date of Birth
MM slash DD slash YYYY
Child #3 Name
First
Last
Child #3 Date of Birth
MM slash DD slash YYYY
Child #4 Name
First
Last
Child #4 Date of Birth
MM slash DD slash YYYY
Child #5 Name
First
Last
Child #5 Date of Birth
MM slash DD slash YYYY
Consent
*
I understand that my demographic information will be collected and stored within the Family and Community Health Data System and shared with the Division of Public Health. Personally identifiable data is collected for the purpose of program evaluation and reporting required to maintain funding. DPH will not disclose identifying information on families and all data used for reporting purposes is deidentified.
*
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