Participants name:
Partners Name:
Class You Wish to Attend:Saturday
Phone Number:
Address:
  Please Check All That Apply:Foster Parent  Adoptive Parent  Birth Parent  Grandparent
Step-Parent    Other: (Please Describe)    
Ages of Children:
Are you Required To Take a Parenting Class?:Yes     No
If So, By Whom?:
How Did You Hear Of This  Class?:
Amount Paid Via Paypal or Mail:     Amount Paying:            Paypal     OR     Check
Terms and Conditions:
We are currently offering a Saturday class.
This is a 8-week class, meeting in May/June
for 8 Saturdays, from 9:30am to noon.

Certificates of attendance will be issued at the completion
of the entire class course.

Cost is $200.00 per family + cost of book ($20.00).  This is non-refundable, however credit may be given
to attend a later class if you cannot make it.  Classes
are limited in size therefore cancellation needs to be
given far in advance as possible, so others may be able to
attend.

Childcare may be available for a fee.   This is by reservation
only.  If you need child care  please let me know by phone
at least one week in advance.  

Please mail check and registration form to: Terri Kirschner at
247 Monroe Pl. Monrovia, CA. 91016

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