Please fill out the following form and we will contact you
for payment arrangements. Thank you!

YOU WILL BE CONTACTED BY PHONE OR EMAIL TO CONFIRM YOUR REGISTRATION.  IF YOU DO NOT HEAR FROM US WITHIN 5 DAYS, CALL TO CONFIRM. 
*asterisked items are required

*First & Last Name

*Daytime Phone

Home Phone (if different)

*Street Address

*City

*Zip

*Other Parent's Name(if not applicable, write NA)

*Whether it is OK for the other parent to take the same class(if not applicable, write NA)

Preferred Date(s)

You can check the calendar  for a list of available classes and locations

Hint: For Consider the Children, look for "CTC" and the county you are interested in; for Impact of Domestic Violence, look for "DV"; click on the heading to find out more

Preferred county

(we will schedule where you live unless we hear otherwise)

Other information we might need (enter your e-mail address if you desire e-mail confirmation)

Optional:  Click here to pay with PayPal* VERY IMPORTANT: Be sure to return here, using the Back button on your browser, and submit your registration form or your registration will not be submitted.