[et_pb_section fb_built=”1″ _builder_version=”4.18.0″ _module_preset=”default” background_color=”#FFFFFF” background_enable_pattern_style=”on” background_pattern_style=”zig-zag” background_pattern_color=”rgba(0,0,0,0.03)” custom_margin=”0px||0px||true|false” custom_padding=”0px||0px||true|false” hover_enabled=”0″ global_colors_info=”{}” sticky_enabled=”0″][et_pb_row _builder_version=”4.18.0″ _module_preset=”default” background_color=”#64b445″ max_width=”800px” module_alignment=”center” custom_margin=”0px||0px||true|false” custom_padding=”0px||0px||true|false” hover_enabled=”0″ global_colors_info=”{}” width_last_edited=”on|phone” width_phone=”100%” custom_margin_last_edited=”on|phone” custom_margin_phone=”|0px||0px|true|false” custom_padding_last_edited=”on|phone” custom_padding_phone=”0px|0px|0px|0px|true|false” sticky_enabled=”0″ max_width_last_edited=”on|phone” max_width_phone=”100%” custom_margin_tablet=”0px||0px||true|false” custom_padding_tablet=”0px||0px||true|false” max_width_tablet=”800px”][et_pb_column type=”4_4″ _builder_version=”4.18.0″ _module_preset=”default” hover_enabled=”0″ global_colors_info=”{}” sticky_enabled=”0″][et_pb_image src=”https://thomaspuckett.com/wp-content/uploads/2022/09/the_kids.jpg” alt=”the_kids” title_text=”the_kids” show_bottom_space=”off” _builder_version=”4.18.0″ _module_preset=”default” custom_margin=”0px|0px|0px|0px|false|true” custom_padding=”0px|0px|0px|0px|false|true” hover_enabled=”0″ global_colors_info=”{}” sticky_enabled=”0″][/et_pb_image][et_pb_text _builder_version=”4.18.0″ _module_preset=”default” text_font_size=”18px” header_3_font=”|800|||||||” header_3_text_color=”#23408f” header_3_font_size=”36px” header_3_line_height=”1.3em” text_orientation=”center” background_layout=”dark” custom_margin=”50px|0px||0px|false|false” custom_padding=”|30px||30px|false|true” hover_enabled=”0″ global_colors_info=”{}” sticky_enabled=”0″ custom_margin_last_edited=”on|phone” custom_margin_tablet=”50px|0px||0px|false|false” custom_margin_phone=”50px|0px||0px|false|false”]

Thank you for your interest in our focus group.

Please fill in the form below for consideration.

[/et_pb_text][et_pb_code _builder_version=”4.18.0″ _module_preset=”default” custom_padding=”0px|30px|30px|30px|false|false” global_colors_info=”{}” custom_padding_last_edited=”on|phone” custom_padding_phone=”|10px||10px|false|true” hover_enabled=”0″ sticky_enabled=”0″ custom_padding_tablet=”0px|30px|30px|30px|false|false”]

CHC Parent Form
Do you have children in childcare?
Ethnicity (to make sure all are represented in our discussions)
Select all that apply.
Your Availability:

[/et_pb_code][/et_pb_column][/et_pb_row][/et_pb_section]