Empowered Fatherhood™ Registration Form

Workshop Registration Form

Empowered Fatherhood™ is a 6-week series meeting on Saturdays, facilitated by Greater Changes and made possible through the VI Access and Visitation Program. Each session builds on the last, covering fatherhood identity, communication, emotional wellness, co-parenting, and family healing. The program concludes with a Closing Ceremony honoring your commitment and growth. Sessions are free and held on St. Croix, USVI. The program will also be hosted virtually on Zoom.
Participant Information
Name

First NameLast Name
Age
Gender Identity
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Mailing Address

Address

Address Line 2
CityState / ProvincePostal / Zip Code
Preferred Contact Method
Island of Residence
How will you be attending?
How did you hear about this program?

Other
If referred, by whom?
Fatherhood & Family Information
Number of Children
Ages of Children
Do you currently live with your child(ren)?
Current Co-Parenting Status
Are you currently involved in a family court case?
Program Acknowledgment
Empowered Fatherhood™ meets on Saturdays for 6 consecutive weeks. Attendance at all sessions is encouraged to get the full benefit of the program. The series concludes with a Closing Ceremony celebrating participants' growth and commitment.
Signature
Today’s Date

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Date
Signature
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Workshop Registration Form