Course Registration Form

Registration Form

Fill out the form carefully for registration
Name

First NameMiddle NameLast Name
Birth Date

MonthDayYear
Gender
Client Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Client E-mail
example@example.com
Probation Officer/Attorney Number
Format: (000) 000-0000.
Probation Officer/Attorney Name
Email
example@example.com
Courses
ATTENTION:

Registration Fee $25 ( You are required to pay via zelle 2anchorhope@gmail.com

IOP $30 per session/hour you are required to take 10 hours per week for 12 weeks

Tuesday, Wednesday, Thursday 6-8 pm

SOP $30 per session/hour you are required to take 2 hours per week for 10 weeks

Wednesday, 6-8 pm

Payment is due 2 hours prior to class start time. If you do not pay you cannot attend.
Should be Empty: