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Registration for Strengthening Families 10-14 Program
Use this form to sign up for this family education program. It runs from 6-8 pm with free dinner from 5:30-6 pm which we encourage everyone to attend if possible. In the first hour caregiver/parents and youth meet separately, then in the second hour everyone is together and you are with your family. If you have questions, you can contact Ruth Ever, the organizer, directly at 413-207-5725 or coalition@epsd.us.
Everyone is welcome! The program meets at White Brook Middle School, 200 Park St. in Easthampton.
Which session are you interested in? *
Required
Name of Parent/Caregivers Participating: *
Your answer
Email for Caregiver(s) *
Your answer
Telephone number for caregiver(s) *
Your answer
Best way to contact:
Home Address: *
Your answer
Names of Youth Participating. Include Age and School: *
Your answer
Names of kids needing childcare. Include ages: (Childcare is available onsite)
Your answer
Will you be attending the free dinner each week between 5:30-6 pm?
Do you have any food issues we should know about?
Your answer
Is there anything else that is helpful for us to know about your family before the program starts?
Your answer
How did you hear about the Strengthening Families 10-14 program?
Your answer
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