Nourish and Nurture: Nutrition Class Registration
Full Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
E-mail
*
example@example.com
Birth Date
*
/
Month
/
Day
Year
Date
Due Date
*
-
Month
-
Day
Year
Date
Please select which class you'll be attending:
*
Please Select
January 14th, 2026: 10:00am-11:30pm
February 11th, 2026: 10:00am-11:30am
Will anyone be attending class with you? (Everyone is welcome to bring a support person to each class).
*
Yes
No
Name of the person attending & their relationship to you.
We provide childcare during our classes for children 6 and under. Will you need childcare?
*
Yes
No
If yes, for how many children? what are their ages?
*
Submit
Should be Empty: