Early Education Registration Form Early Education Groups Form "*" indicates required fields Paren'ts Name*Child's Name*Child's Date of Birth* MM slash DD slash YYYY Address* Street Address City State / Province / Region ZIP / Postal Code Phone Number*Email*Vision Forward Service ProviderColleenKatieTinaDanaProgram Group Option (please select one)*EYE GrowEYE PlayEYE LearnEYE ExploreCLTS Service Coordinator's InformationChildren’s Long Term Support Waiver Program accepted. Please contact your CLTS service coordinator prior to registering. Coordinator's Name First Last PhoneCountyFor questionsContact Colleen Kickbush for questions and/or payment arrangements at 414-615-0160 or email ckickbush@vision-forward.org.
