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When Burlington parents come together through YouParent, we all keep our kids safe and supported. Complete the form below to start receiving information from YouParent!

Online Support through email, text and Facebook

Personal Support through small groups with other parents

Resources, activities and tips to use at home with your kids

All information collected in the form below will be used only to send you developmentally appropriate information for the current age of your children and for our evaluation purposes. All information you provide will remain confidential and will not be shared with any other parties outside of the YouParent Program collaborators. Participation in this program is voluntary. You may unsubscribe from our mailings at any time.





Parent/Guardian’s Full Name (required)

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Please help us gather information about the age of your children so we can send you developmentally appropriate information.

First Child

Child’s First Name

Child’s Date of Birth

Gender?

Name of School Child Attends (required)

Second Child

Child’s First Name

Child’s Date of Birth

Gender?

Name of School Child Attends (required)

Third Child

Child’s First Name

Child’s Date of Birth

Gender?

Name of School Child Attends (required)

Additional Children

Please let us know the name and ages of any additional children you may have

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© 2013 Burlington Partnership for a Healthy Community



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