YWCA York's Mindful Parenting Workshop Registration Form

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* 1. Please answer the below questions:

Name *

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

Email Address

Phone Number *

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* 2. Ethnicity

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* 3. Age

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* 4. How many children do you have? And what are their ages?

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* 5. Do any of your children attend YWCA York's programs?

No

Yes

If answer is yes, what programs:

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* 6. Which FREE Mindful Parenting Workshop are you registering for?

Monday, March 11, 12-2pm, Strengthening Your Connection to Your Child

Friday, April 26, 3-5pm, Positive Behavior Supports and Approaches

Tuesday, May 14, 12-2pm, Supporting Your Child's Development

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* 7. How did you hear about this workshop?