Class Registration

Class Registration

    Parenting Class:

    Choose a Class:*
    Group Triple PTeen Group Triple PFamily Transitions

    Demographics:


    ADULT 1


    ADULT 2

    *Leave “adult 2” blank if registering alone.


    Contact Information:

    *Only one phone number, address,and email needed per household.


    Family Information:


    Children:


    CHILD 1


    CHILD 2


    CHILD 3


    CHILD 4


    CHILD 5


    Referral Information:


    Other Information:

    Do you have any open DCS cases?
    *If yes, please include case/cause number: This information is used for requesting referrals.
    Do you have a restraining order against you or against someone else?
    *If yes, please include the first and last name of the other party on the order.
    Is there someone you would feel unsafe with if they joined the class?
    *If yes, please include their first and last name.
    Any medical conditions that would affect your ability to take the class?
    *If yes, please list them.
    Do you have any learning concerns that would affect your ability to take the class?
    *If yes, please list them.
    Emergency Contact Person:
    *We will only contact this person if there is an emergency.

      Parenting Class:

      Choose a Class:*
      Group Triple PTeen Group Triple PFamily Transitions

      Demographics:


      ADULT 1


      ADULT 2

      *Leave “adult 2” blank if registering alone.


      Contact Information:

      *Only one phone number, address,and email needed per household.


      Family Information:


      Children:


      CHILD 1


      CHILD 2


      CHILD 3


      CHILD 4


      CHILD 5


      Referral Information:


      Other Information:

      Do you have any open DCS cases?
      *If yes, please include case/cause number: This information is used for requesting referrals.
      Do you have a restraining order against you or against someone else?
      *If yes, please include the first and last name of the other party on the order.
      Is there someone you would feel unsafe with if they joined the class?
      *If yes, please include their first and last name.
      Any medical conditions that would affect your ability to take the class?
      *If yes, please list them.
      Do you have any learning concerns that would affect your ability to take the class?
      *If yes, please list them.
      Emergency Contact Person:
      *We will only contact this person if there is an emergency.