Request edit access
Black Parents PEPS Group Registration - June 2022
We're excited to start this eight week journey with you, and we would love to learn more about you, your children and creating this space together.
Sign in to Google to save your progress. Learn more
Email *
Name *
We will connect together on WhatsApp and on Zoom weekly. What is your best phone number? Please make sure we can add this # to our WhatsApp group! *
How old are you? *
Tell us about your children, their names, ages and any other information you would like to share! *
What do you hope to get from participation in this PEPS group? *
Required
We will be able to provide one single delivery of diapers and wipes, clothing for children sizes 0-12 and fresh produce to families in King County. If you are interested in receiving a delivery, please select below.
If you selected YES to one delivery, we will coordinate a volunteer to provide 1 door drop to you. Do you consent to a volunteer receiving your address to complete delivery?
Clear selection
Please provide your delivery address. We will contact you to confirm your delivery address and delivery details.
Do you have any questions for us?
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy