BROOKLYN PARENT WORKSHOP SERIES Survey

1.First Name: (Required.)

2.Last Name: (Required.)

3.Email Address: (Required.)

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

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)

5.Child #1 name:

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

7.Child #2 name:

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

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.

10.How did you learn about this event?

BROOKLYN PARENT WORKSHOP SERIES

We're happy you are joining us!