Empowered Newark Parents: Building Your Family's Social and Emotional Learning Skills

Parent/Caregiver/Community Registration Form

In Partnership with Newark Trust for Education's Safe and Supportive Schools Initiative

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* 1. Date

Date

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* 2. Name:

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* 3. Address:

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

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* 4. Email:

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* 5. Phone #

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* 6. School Name:

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* 7. Child #1 Name:

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* 8. Child #1 Grade:

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* 9. Child #2 Name:

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* 10. Child #2 Grade:

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* 11. Child #3 Name:

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* 12. Child #3 Grade:

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* 13. The SEL workshops are 6 classes held from April 16th - June 14th.
Which session do you want to attend?

Early Childhood South (Tuesdays from 9 am to 11 am):
April 16th, 30th & May 7th, 14th, 21st, 28th.

Thirteenth Avenue School at Rutgers Newark (Fridays from 10 am to 12 pm): May 10th, 17th, 24t, 31st & June 7th, 14th.

Luis Munoz Marin (Fridays from 9 am to 11 am): May 10th, 17th, 24t, 31st, & June 7th, 14th.

McKinley (Tuesdays from 9 am to 11 am): April 16th, 30th & May 7th, 14th, 21st, 28th & June 4th.

Sussex Avenue (Wednesday 4 pm to 6 pm): April 17th and May 1st, 8th, 15th, 22nd

KIPP: NJ (Thursdays from 6 pm to 7:45 pm): April 25th, and May 2nd, 9th, 16th, 23rd, 30th.

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* 14. Would you need childcare?

Yes

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* 15. Would you need translation?

Yes

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* 16. How did you hear about the training?

School staff

Trainer

Flyer

Other (please specify)

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* 1. Date

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* 2. Name:

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* 3. Address:

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* 4. Email:

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* 5. Phone #

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* 6. School Name:

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* 7. Child #1 Name:

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* 8. Child #1 Grade:

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* 9. Child #2 Name:

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* 10. Child #2 Grade:

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* 11. Child #3 Name:

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* 12. Child #3 Grade:

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* 13. The SEL workshops are 6 classes held from April 16th - June 14th. Which session do you want to attend?

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* 14. Would you need childcare?

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* 15. Would you need translation?

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* 16. How did you hear about the training?

* 13. The SEL workshops are 6 classes held from April 16th - June 14th.
Which session do you want to attend?