FY25 SF Enrollment and Informed Consent for PwP

By filling out and signing this form, you are applying to participate in a Play with Purpose play group sponsored by the San Francisco Department of Early Childhood and coordinated by Sparkler and the National Center for Families Learning (NCFL). Play with Purpose is intended to help teach you how to interact with your child to improve your child’s development. If you participate, you must agree to certain things that are outlined below. Please fill out this form carefully and read completely before you sign at the end. Because this is a voluntary program, you may choose to discontinue your participation in the group at any time for any reason.
NOTE: The child’s parent or legal guardian must sign this form. If the primary caregiver applying is not the parent or legal guardian, both must sign this form.

Participating child's information

2. Child's Name *This question is required.

First Name:
Last Name:

3. Child's Date of Birth: *This question is required. This question requires a valid date format of MM/DD/YYYY.

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Participating caregiver's information

4. Participating Caregiver's Name: *This question is required.

First Name:
Last Name:

5. Participating caregiver's preferred language: *This question is required.

6. Participating caregiver's email address: *This question is required. This question requires a valid email address.

7. Participating caregiver's mobile phone number: *This question is required.

Do you need childcare to participate in the program? *This question is required.

Number of children needing childcare: *This question is required.

Age(s) of children needing childcare: *This question is required.

8. Do you have access to the internet in your home? *This question is required.

9. Do you have: *This question is required.Check all that apply.