FACES - Registration Form - Dover

All classes are being held at Wentworth-Douglass Hospital at 789 Central Ave Dover, NH 03820-A uditorium D

Spaulding Tpk. Exit 9 - Use the Old Rollinsford Rd entrance to the hospital.

        To register, complete the form below:

First Name:
(required)
Full Middle Name:
(If no middle name enter "none")
(required)
Last Name:
(required)
Date of Birth:
(Please use this format: mm/dd/yyyy)
(required)
Home mailing address:
(required)
City:
(required)
State:
(required)
Zip code:
(required)
Home Telephone Number:
(Please use this format: xxx-xxx-xxxx)
(required)
Cell Number:
(Please use this format: xxx-xxx-xxxx)
Business Telephone Number:
(Please use this format: xxx-xxx-xxxx)
Primary email address:
(required)

Re-enter email address:

(required)
I am:
(required)
Location of District Office
or name of Private Agency:
(required)
Location of District Office or
name of Private Agency:
(required)
Other (specify role):
(required)
If you have a disability which may require special services, please check here.
Please explain your accommodation needs.
(required)

FACES - Dover Series

Check the box next to each class you want to register for.

Orientation: 1/30/18

Tuesday, 6pm-9pm

Regulations: 2/6/18

Tuesday, 6pm-9pm

The Developing Child: 2/13/18

Tuesday, 6:00pm-9:00pm

The Effects of Childhood Trauma:  2/20/18

Tuesday, 6pm-9pm

Experiencing Grief and Loss:  2/27/18

Tuesday, 6pm-9pm

Promoting Positive Behavior: 3/6/18

Tuesday, 6pm-9pm

Lifelong Connections: 3/13/18

Tuesday, 6pm-9pm

By submitting your registration, you have agreed to allow the Education &Training Partnership to share your course participation and completion information with the New Hampshire Division for Children Youth & Families (DCYF).

Payment Options