Families in Transition Class Registration
Fill out the form carefully for registration, please read all instructions
Cause Number
*
Party
*
Petitioner
Respondent
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Class Date
July will be posted soon
Class Dates
June 26
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First Name
*
Last Name
*
E-mail
*
Contact Number
-
Area Code
Phone Number
Address
City
State
Zip Code
Number in household
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Gender
Please Select
Male
Female
Other
Prefer not to say
Age
Race
Caucasian
African-American
Asian
Hispanic
Bi-Racial
Multi- Racial
Other
Ethnicity
Hispanic
Non-Hispanic
Employment Status
Please Select
Full Time
Part Time
Self-Employed
Unemployed
Job Searching
Disabled
Stay at Home Parent
Household Income
Whole Number
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Children’s Names and Ages
*
Will You be bringing your children to the class?
Yes
No
Choose a Class Date
June 24
If youth are between 6-18 they need to attend a class. Class will be held from 5-8 p.m. at the Youth Connections office. Pizza and juice will be provided to the youth.
Does child have any food allergies we should be aware of?
Yes
No
List allergies
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Are you on any type of government assistance?
*
Yes
No
Upload documentation of your government assistance.
*
Browse Files
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Class Fee
*
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( X )
Adult Class Fee
$
128.00
Enter coupon
Apply
Total
$
0.00
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Submit
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