BROOKLYN PARENT WORKSHOP SERIES

We're happy you are joining us!

So glad to see that you will be attending one (or several) of our upcoming parent workshops. Please give us a little bit of information about you and your family so we can be sure to be ready for you.

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* 1. First Name:

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* 2. Last Name:

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* 3. Email Address:

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* 4. Which workshop(s) will you be attending?

WEBINAR: PHONE NUMBER & PIN CODE FOR ACCESS WILL BE EMAILED FOLLOWING REGISTRATION.

August 15 @ 12:30 - 1:30 PM: Bright Horizons at 345 Adams Street
"Getting Out of the House on Time With Kids"
(presented by Shira Eisenberg, BCBA, of Real Parenting)

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* 5. Child #1 name:

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* 6. Child #1 date of birth: (mm/dd/yyyy)

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* 7. Child #2 name:

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* 8. Child #2 date of birth: (mm/dd/yyyy)

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* 9. Are you interested in learning more about Bright Horizons and speaking to an Enrollment Counselor?

Yes, I would like to be contacted by an Enrollment Counselor.

No, I am not yet ready to speak with an Enrollment Counselor.

No thanks, I am already REGISTERED at a Bright Horizons center.

No thanks. I am already ENROLLED at a Bright Horizons center.

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* 1. First Name:

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* 2. Last Name:

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* 3. Email Address:

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* 4. Which workshop(s) will you be attending?

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* 5. Child #1 name:

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* 6. Child #1 date of birth: (mm/dd/yyyy)

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* 7. Child #2 name:

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* 8. Child #2 date of birth: (mm/dd/yyyy)

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* 9. Are you interested in learning more about Bright Horizons and speaking to an Enrollment Counselor?

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* 10. How did you learn about this event?