ENROLL TODAY!

AN ONLINE ENROLLMENT FORM

Online Enrollment Form

Enroll in Help Me Grow to: (1) regularly receive developmental questionnaires, (2) get connected to developmental resources within your community, (3) be empowered to take an active role in your child’s healthy development.

 

Please fill out the form below. After submitting this form, a member of the Help Me Grow team will contact you to learn more about your family’s needs or interests.

 

* indicates required field

HELP ME GROW ENROLLMENT FORM

 
 
 
 
 
 
 
 
 
     
For grant purposes, please indicate the following:
 
 
Please indicate your family's health insurance (insurance is not required to receive Help Me Grow services):
 
 
 
 
 
 
 

Child Information

 
Child 1

 
Child’s Date of Birth (or Due Date):
 
 
 
   
   

 
Child 2
 
 
Child's Date of Birth (or Due Date):
 
 
 
   
   

 
Child 3
 
 
Child's Date of Birth (or Due Date):
 
 
 
 
 
   
 

When using Help Me Grow Alabama (HMGA), basic information is collected about your family and the services provided. With your permission, HMGA communicates with your family’s physician(s) and other providers. HMGA also teams with other entities to share data that gives an overall view of how Alabama’s children are doing. Your personal information will always be removed before use in research, community coordination or to inform future decision making. By using HMGA services, you are consenting to the sharing of your information unless you ask otherwise. For more details, please contact the Help Me Grow main office.

Every family will have the desire, resources, and confidence to make the best decision for their child’s development. Also, every child will be screened using a valid, evidenced-based tool starting at birth.

Our Vision

Help Me Grow Alabama

Help Me Grow Alabama is a program of the Alabama Partnership for Children as an affiliate of the Help Me Grow National Network.

 

Help Me Grow Alabama is funded by the Alabama Department of Early Childhood Education through the Preschool Development Grant, the Alabama Department of Human Resources, and the Alabama Department of Mental Health through a Project LAUNCH Grant from the Substance Abuse and Mental Health Services Association. In addition, Help Me Grow Alabama is supported by an AmeriCorps State Grant from the Corporation for National and Community Service provided by The Governor's Office of Volunteer Services.

 

Help Me Grow Alabama partners with 2-1-1 Connects Alabama for implementation in nine regions of the state.

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