Want to Learn How to Juggle? Presented by Jeremy Vik Question Title * 1. I would like to register for: Want to Learn How to Juggle?Every Monday from 10-10:30amYou are welcome to join in anytime! Question Title * 2. Name: First: Last: Question Title * 3. Affiliation: Adoptive Parent Foster Parent / Kinship Care Parent Social Services Professional Family Resource Center Health Care Professional / Administration Mental / Behavioral Health Professional Public Health Professional / Administration Teacher - Preschool Teacher - Elementary School College Faculty / Administration Law Enforcement Tribal Program Student County Supervisor County Administration Other (please specify) Question Title * 4. Phone Number: Question Title * 5. E-mail Address: Question Title * 6. Free juggling balls will be mailed to participants of this class. Please list your mailing address below: Question Title * 7. How many in your family will be learning how to juggle in this class? Question Title * 8. Would you like to receive, by e-mail, information about future trainings in our county? Yes No Done
