FACES - Registration Form - Keene

All classes will be held at Crossway Church, 28 Arch St., Keene, NH 03431

 

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)

A valid MAILING ADDRESS is required.

City:

(required)

State:

(required)

Zip code:

(required)

Primary Telephone Number:
(Please use this format: xxx-xxx-xxxx)

(required)

*NOTE: Shared email addresses are not allowed. Please use a unique email address for each registration*

Primary E-mail 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 - Keene Series

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

Orientation - 1/22

Tuesday 6:00pm-9:00pm

Regulations - 2/5

Tuesday 6:00pm-9:00pm

The Developing Child - 2/19

Tuesday 6:00pm-9:00pm

The Effects of Childhood Trauma - 2/26

Tuesday 6:00pm-9:00pm

Experiencing Grief and Loss - 3/5

Tuesday 6:00pm-9:00pm

Promoting Positive Behavior -3/19

Tuesday 6:00pm-9:00pm

Lifelong Connections - 3/26

Tuesday 6:00pm-9:00pm

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
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