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Dad 2 Dads Registration
Thank you for your interest in Dad 2 Dads. Please complete the information below and we will follow up with you. If you have questions, please contact or office at 757-337-3429 or email us at dads@theupcenter.org.
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1.
Last Name
(Required.)
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2.
First Name
(Required.)
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3.
Contact Information
(Required.)
Address
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Address 2
City/Town
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State/Province
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ZIP/Postal Code
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Email Address
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Phone Number
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4.
Please identify your age group.
(Required.)
6 to 12
13 to 17
18 to 24
25 to 34
35 to 44
45 to 54
55 to 64
65 an up
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5.
Please identify your race/ethnicity.
(Required.)
Black/African American
White
Hispanic/Latino
Asian/Asian American
American Indian/Native
Hawaiian/Pacific Islander
Other
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6.
Please identify your military affiliation.
(Required.)
Active Duty
Veteran
Military Dependent/Family Member
None
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7.
What services are you interested in?
(Required.)
Dads Under Construction (groups for expecting and new Fathers)
Dad 2 Dads (groups for Fathers and Father Figures)
1 to 1 support (connection to community resources)
Other (please specify)
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8.
How did you hear about us?
(Required.)
Social Media
The Up Center's website
Google Search
Community Event
Doctor's Office
Healthy Families Program
Parents as Teachers Program
Counseling Program
Housing & Financial Counseling Program
Department of Social Services
Radio
TV appearance
Other (please specify)
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9.
I would like more information about the following topic(s). Select all that apply.
(Required.)
Parenting Skills
Mental Health
Healthy Living
Co-parenting
Financial Literacy
Housing
Education
Employment
Baby Supplies
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10.
Please share the number of children you are the parent, guardian, or caretaker of who are 0-17 years old?
(Required.)
*
11.
Are you expecting a new baby?
(Required.)
Yes
No
