Parenting Enrichment Course Registration
Fill out the form carefully for registration. To secure your spot in the next class, payment must be made in advance. You can pay here using a debit or credit card. You may also bring cash or a money order to our office. If you have any questions, please contact our Parenting Director, Lynn Hooper, at (864)-467-4099 or info@justsaysomethingsc.org!
Participant Name
*
First Name
Last Name
Participant E-Mail Address
*
example@example.com
Participant Phone Number
*
Please enter a valid phone number.
Participant Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date of Birth
*
/
Month
/
Day
Year
Relationship to Child
*
Mother
Father
Grandparent
Guardian
Other
Emergency Contact Name
First Name
Last Name
Emergency Contact Phone Number
Please enter a valid phone number.
Would you like to register an additional participant for this course?
Yes
No
Back
Next
Additional Participant Information
Please provide the following information for the second parent or guardian that will be participating in the course.
Participant Name
First Name
Last Name
Participant E-Mail Address
example@example.com
Participant Phone Number
Please enter a valid phone number.
Participant Address (if different)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date of Birth
/
Month
/
Day
Year
Relationship to Child
Mother
Father
Grandparent
Guardian
Other
Back
Next
Additional Information
Please provide the following information.
Number of children in family
Our courses are for PARENTS and GUARDIANS only. Unfortunately, children may not attend.
Ages of children in family
Have you previously taken a parenting class? If so, where?
How did you hear about Just Say Something?
DSS or Family Court
Attorney
Website
Word of Mouth
Other
DSS or Family Court County
Social Worker's Name
First Name
Last Name
Social Worker's Phone Number
Please enter a valid phone number.
Social Worker's Email Address
example@example.com
Did DSS specify which course to take? If so, which one?
Back
Next
Course Selection
IF YOU LIVE IN GREENVILLE COUNTY, ALL PARENTING COURSES ARE FREE TO ATTEND. Click "YES" to answer the question below, then click the Parenting Enrichment Course(s) for which you would like to register. IF YOU DO NOT LIVE IN GREENVILLE COUNTY, ALL PARENTING COURSES ARE NOT FREE TO ATTEND. Once you have answered "NO" to the question below, go to " Non-Greenville County Residents: How are you paying for your registration?" section and then proceed downwards to complete your registration.
Do you reside in Greenville County?
Yes, I am a Greenville County Resident.
No, I am not a Greenville County Resident.
Greenville County Residents: Click the Parenting Enrichment Course(s) for which you would like to register.
Back in Control - Participant - $70
Back in Control - Couple - $120
Parenting Wisely - Participant - $60
Parenting Wisely - Couple - $100
Transparenting - Participant - $50
Transparenting - Couple - $90
Additional Certificate of Completion - $5
Non-Greenville County Residents: How are you paying for your registration?
Debit or Credit Card
Non-Greenville County Residents: Click the Parenting Enrichment Course(s) for which you would like to register, enter your credit card information, and click to submit.
prev
next
( X )
Back in Control - Participant
Back in Control course registration for 1 participant.
$
70.00
Back in Control - Couple
Back in Control course registration for 1 couple.
$
120.00
Parenting Wisely - Participant
Parenting Wisely course registration for 1 participant.
$
60.00
Parenting Wisely - Couple
Parenting Wisely course registration for 1 couple.
$
100.00
Transparenting - Participant
Transparenting course registration for 1 participant.
$
50.00
Transparenting - Couple
Transparenting course registration for 1 couple.
$
90.00
Additional Certificate of Completion
A certificate of completion is provided with each of our Parenting Enrichment Courses. If you would like an additional or replacement copy made, we can do so for a $5 fee.
$
5.00
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Questions or comments?
Submit
Should be Empty: