KEEP for Kin Interest Form

Name: *

First

Last

County of Residence:

Phone

Contact Email:

Best method of contact:

Best time of day for us to contact you:

Ages of kinship children in your home (please check all that apply)

Best days of the week and times for group (please check all that apply):

Language/ Communication Options:

Are you interested in a child-specific group?

Parents caring for youth who entered the US without an adult (unaccompanied minor)
Parents caring for youth identifying as LGBTQIA+

(Optional) Anything else you'd like us to know?