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Follow Along Program

Welcome to the Follow Along Program Online Enrollment Form

Please complete the enrollment form below and click submit when finished. Only the starred * fields are required, however, any additional information you provide will help us connect you with other local early childhood resources you might be interested in.

The information collected on this form will be used to link you with the local public health staff in your county that provide the Follow Along Program. All of the information on this form is confidential and will only be used for Follow Along Program participation. If you have any questions, please contact the state program coordinator at; (651) 201-3641 or toll free 1-800-728-5420.

Child/Family Primary Address (* signifies a required field)

*Please note: The Follow Along Program is not currently available in the following counties: Anoka, Blue Earth, Crow Wing, Faribault, Martin, Ramsey, and Stearns. If you live in one of these counties and would like to be connected to other early childhood resources, please submit the enrollment form and the state program coordinator will contact you.

Guardian Information (* signifies a required field)

Insurance (Check all that apply) *

Child Information (* signifies a required field)

Child's Gender *
Hispanic or Latino *
Race/Ethnicity (Check all that apply) *
Was the child born prematurely? (born before 37 weeks gestation) *
Were there any pregnancy concerns? *
Was the child in the NICU (Neonatal Intensive Care Unit)? *
Does the child have any health conditions or diagnoses? *
At birth, was the child's hearing tested in the hospital? *
Do you have concerns about the child's development? *
How did you hear about the Follow Along Program? (Check all that apply)