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Exposure Group Interest Form

Please complete the following form to express interest in registering your child for our Exposure Group! If registering siblings, please fill out one form per child. After reviewing your information, our intake coordinator will contact you and get you started with the registration.

Our exposure group will be held on the first Sunday of each month starting Feb 5, 2023.

Please complete the form below

Child's Name

First Name

Last Name

Parent/Legal Guardian's Name

First Name

Last Name

Phone

(###)

###

####

Age of Child?

Is Your Child a Current Pinnacle Client?

How Did You Hear about our Exposure Group?