Wellness

1. Wellness

Thursday Theater is a free monthly workshop for parents of children with special needs. Join us for a relaxing morning to focus on taking care of yourself and your relationships

Thursday, November 12, 2009
10:00 a.m. - 12:00 p.m.

City of Fairfax Regional Library
10360 North Street
Fairfax, Virginia 22030

1. Name

Name

2. phone number

phone number

3. e-mail address

e-mail address

4. How did you hear about this workshop?

	Please Check answer
PRC web site	How did you hear about this workshop? PRC web site Please Check answer
PRC Newsletter	PRC Newsletter Please Check answer
Keep In Touch Email	Keep In Touch Email Please Check answer
Flyer sent home	Flyer sent home Please Check answer
Parent group	Parent group Please Check answer
Listserv	Listserv Please Check answer

Other (please specify)

5. Accommodations are available for workshops. Please let us know
two weeks in advance if you need any of these services or contact
the PRC at 703-204-3941.

	Yes	No
Do you need accommodations to attend this workshop?	Accommodations are available for workshops. Please let us know two weeks in advance if you need any of these services or contact the PRC at 703-204-3941. Do you need accommodations to attend this workshop? Yes	No

Please provide a short description of required needs?

6. Interpreters are available for workshops. Please let us know
two weeks in advance if you need any of these services or contact
the PRC at 703-204-3941.

	Yes	No
Do you need an interpreter to attend this workshop?	Interpreters are available for workshops. Please let us know two weeks in advance if you need any of these services or contact the PRC at 703-204-3941. Do you need an interpreter to attend this workshop? Yes	No

Please provide a short description of required needs?

7. Additional Participants: If you are registering additional
participants,please indicate the total number in your group.

Additional Participants: If you are registering additional
participants,please indicate the total number in your group.
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