FACES - Registration Form - Berlin

All classes will be held at Androscoggin Valley Hospital, 59 Page Hill Rd., Berlin, NH.

        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)

Street:

(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)

FACES - Berlin Series

This series is FULL.  Please check the box below to be added to the wait list for all courses.

Please check here to be added to the wait list.  

Orientation - 1/27

Monday, 5:30pm-8:30pm

Regulations - 2/3

Monday, 5:30pm-8:30pm

The Developing Child - 2/10

Monday, 5:30pm-8:30pm

The Effects of Childhood Trauma - 2/17

Monday, 5:30pm-8:30pm

Experiencing Grief & Loss- 2/24

Monday, 5:30pm-8:30pm

Promoting Positive Behavior - 3/2

Monday, 5:30pm-8:30pm

Lifelong Connections -3/9

Monday, 5:30pm-8:30pm

 

Payment Options