FRC Program Registration Survey

Please enter the people in your family that will participate in the program on this page. Please enter adult and children in the appropriate areas by entering the full name of each participant. If more than 7 participants will be attending please include them in the comments section at the end.

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1. Participant(s):

Participant(s): Adult's Name:
Adult's Name:
Adult's Name:
Child's Name & Age:
Child's Name & Age:
Child's Name & Age:
Child's Name & Age:

2. Do any of the participants require accommodations?

Do any of the participants require accommodations? No

Yes

If yes, please specify.

3. All of the above participants are registering for the following program(s).

All of the above participants are registering for the following program(s). Kids Nutrition Corner: We Are the Champions! - 09/15/11

Potty Like a Rock Star! - 09/26/11

ArtSmart: Sock It To Me! - 9/29/11

FRC Fall Fest - 10/6/11

Meet Us at the Firehouse -10/11/11

ArtSmart: Collage College - 10/13/11

The Nurtured Heart Approach - 10/17/11

Kids Nutrition Corner: Witching You a Happy Halloween! - 10/19/11

Piggy Palooza - 10/26/11

Living with Allergies and Gluten-Free Living - 10/27/11

Kids Nutrition Corner for Big Kids! - 11/3/11

Love and Logic for Preschool Parents - 11/7, 11/14, 11/21, 11/28/11

ArtSmart: Mobile Madness! - 11/10/11

Kids Nutrition Corner: Thankful for You! - 11/17/11

Winter Wonderland - 11/30/11

Kids Nutrition Corner: Friends are the Best Gifts - 12/7/11

ArtSmart: Wrap Happy - 12/8/11

Kids Nutrition Corner: Simmering Soup-er Bowl! - 1/16/11

Reality Parenting - 1/24/12

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4. Please enter your contact information here.

Please enter your contact information here. Address:
Address 2:
City/Town:
State:
ZIP/Postal Code:
Email Address:
Phone Number:

5. How would you like to receive your confirmation?

How would you like to receive your confirmation? Email

Phone

6. Would you like to receive email updates from the Family Resource Center?

Would you like to receive email updates from the Family Resource Center? Yes

7. How did you hear about the program(s)?

How did you hear about the program(s)? Facebook FRC Website Counselor/Clergy TV/Radio/Newspaper County Health Dept. Website/Internet	Health Care Provider School Staff Brochure Prenatal/Birthing Class Friend/Relative Information & Referral Hotline	Flyer/Catalog Dept of Health & Human Services FRC Staff Other
Other (please specify)

8. If the above participants will not be attending all of the programs selected above, please indicate who will attend each program. Also include any additional comments that pertain to your registration.

If the above participants will not be attending all of the programs selected above, please indicate who will attend each program. Also include any additional comments that pertain to your registration.

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9. How do you plan to pay for your registration fee(s)? Please note registration must be received within 7 days of the date of the program to secure your reservation.

How do you plan to pay for your registration fee(s)? Please note registration must be received within 7 days of the date of the program to secure your reservation. mail in a check

pay via credit card/paypal (link provided in confirmation email)

drop off cash/check at PFRC

drop off cash/check at SFRC

Other (please specify)

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10. How would you rate today's online registration experience.

	Yes	No
Registering online was convenient.	*How would you rate today's online registration experience. Registering online was convenient. Yes	Registering online was convenient. No
I would register online again.	I would register online again. Yes	I would register online again. No
Registering online was easy.	Registering online was easy. Yes	Registering online was easy. No

FRC Program Registration
Exit this survey

1. Participants

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1. Participant(s):

2. Do any of the participants require accommodations?

3. All of the above participants are registering for the following program(s).

*
4. Please enter your contact information here.

5. How would you like to receive your confirmation?

6. Would you like to receive email updates from the Family Resource Center?

7. How did you hear about the program(s)?

8. If the above participants will not be attending all of the programs selected above, please indicate who will attend each program. Also include any additional comments that pertain to your registration.

*
9. How do you plan to pay for your registration fee(s)? Please note registration must be received within 7 days of the date of the program to secure your reservation.

*
10. How would you rate today's online registration experience.

FRC Program RegistrationExit this survey

1. Participants

*1. Participant(s):

2. Do any of the participants require accommodations?

3. All of the above participants are registering for the following program(s).

*4. Please enter your contact information here.

5. How would you like to receive your confirmation?

6. Would you like to receive email updates from the Family Resource Center?

7. How did you hear about the program(s)?

8. If the above participants will not be attending all of the programs selected above, please indicate who will attend each program. Also include any additional comments that pertain to your registration.

*9. How do you plan to pay for your registration fee(s)? Please note registration must be received within 7 days of the date of the program to secure your reservation.

*10. How would you rate today's online registration experience.

FRC Program Registration
Exit this survey

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1. Participant(s):

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4. Please enter your contact information here.

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9. How do you plan to pay for your registration fee(s)? Please note registration must be received within 7 days of the date of the program to secure your reservation.

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10. How would you rate today's online registration experience.