QPR - January 30, 2017

When: Monday, Jan 30, 2017, 6:30pm-9:00pm

Where: Newton City Hall, 1000 Commonwealth Ave, Room 211 on the 2nd floor.

A light dinner will be provided

This registration is for Monday, January 30,2017.
If you want to register for another date visit www.newtonma.gov/newtoncares and click on the registration link for the date you want.

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* 1. Person attending training

Name:

Email Address:

Phone Number:

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* 2. I am a (please select all that apply):

Parent/guardian of a Newton Public Schools student

Parent/guardian of a private school student

Interested community member

Mental health professional

City of Newton Employee

Clergy or member of a faith-based organization

Andover Newton student/faculty/staff

Other (please specify)

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* 3. Which of the following best describes your age (please note, this training date is intended for adults):

18 to 29

30 to 49

50 to 69

70 and older

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* 1. Person attending training

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* 2. I am a (please select all that apply):

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* 3. Which of the following best describes your age (please note, this training date is intended for adults):

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* 4. If you are in need of a reasonable accommodation due to a disability to attend this training, please indicate below.