Class Registration

CLASS REGISTRATION

First Name*

Last Name*

E-Mail*

Telephone*

Address*

City*

State*

Zip*

I want to enroll in the Parenting & Life Skills Program and plan to attend the next orientation.

I want to register for the next session of the following classes:

Healthy Pregnancy	Thrifty Moms
Childbirth	Biblical Parenting
Breastfeeding Basics	The Christian Answer
Baby Care Basics	Life After Abortion

(To register for Car Seat Safety, please contact your local health department; see here for details.)

Bringing your partner or friend to class with you? Please list their names, relationship to you, and the classes they will attend:

Questions or comments:

*Required fields. By submitting this form, I agree to the Site Terms of Service.