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Incredible Years Parenting Class
Tell us a little about you......
Please tell us about you and your child. We will contact you to confirm your registration for this great program. Space is limited so don't delay.
1.
What is your first name?
2.
What is your last name?
3.
Are you a parent?
Yes
No (please explain)
4.
Age of your child?
3
4
5
6
7
8
9
10
11
12
5.
How many adults will be attending the class?
mother
father
Other (please specify)
6.
What is your street address?
7.
What county do you live in?
Buncombe
Haywood
Madison
Other (please specify)
8.
What are the children's name and ages?
9.
What is your email?
10.
What is your phone number?
11.
What is the best way to contact you?
phone
email
text
Other (please specify)
12.
Is this your first time attending a meeting using Zoom or other virtual platform?
I have NEVER used Zoom
I have used Zoom
I am very comfortable using Zoom, etc.
13.
How did you hear about the program? Who referred you?
