Parenting with Love & Logic (TM) Class Registration

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* 1. Please provide your contact information:

Name:

Address:

City/Town:

State:

ZIP:

Email Address:

Phone Number:

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* 2. Ages of your children or the children you work with:

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* 3. Do you require childcare in order to attend?

Yes, I need childcare for the children listed above

No, I do not need child care

Other (please specify your needs)

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* 4. How did you learn about this program offering?

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* 5. What county do you live in?

Audubon County

Carroll County

Greene County

Guthrie County

Sac County

Other (please specify)

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* 6. Which area are you planning to attend a class:
class reqs min of 5 or will be cancelled- tell a friend!

Sac City - Spring 2020

Wall Lake - November 2019

Carroll - Spring 2020

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* 7. How many adults are you registering? (Sorry, children are not allowed to attend class)