FACES - Registration Form - Dover

All classes are being held at:

Wentworth-Douglass Hospital

789 Central Ave, Dover, NH 03820

 

        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)

A valid *HOME* MAILING ADDRESS is required.

Home mailing address:

(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)

This course is full.  Please check the box if you would like to be added to the waitlist.

Orientation -1/9

Thursday, 5:30pm-8:30pm

Regulations - 1/16

Thursday, 5:30pm-8:30pm

The Developing Child - 1/23

Thursday, 5:30pm-8:30pm

The Effects of Childhood Trauma - 1/30

Thursday, 5:30pm-8:30pm

Experiencing Grief & Loss -CANCELED due to weather- new date TBD

 

Promoting Positive Behavior - CANCELED due to weather

New date pending

Lifelong Connections - 2/20

Thursday, 5:30pm-8:30pm

 

Payment Options