Family Engagement Series Registration
FIRST WEDNESDAY OF EACH MONTH (6PM - 8PM) *Excluding July*
Family Contact Information
Please complete the form below
Primary Family Contact:
*
First Name
Last Name
Email:
*
example@example.com
Phone Number:
*
Date of Birth
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Number of Adults Attending
Name & Date of Birth for Adults
Number of Children Attending
Name & Date of Birth of Children
I will need Childcare during the Workshop
Yes
No
Choice of Gas Card or Grocery Card
Grocery Card
Gas Card
Do you have any allergies or dietary restrictions?
*
Attendees that register after 5 PM the Monday before the event are not guaranteed to receive the incentive.
Family Engagement Series Workshops
5/1 - Generational Trauma
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