FAMILY MATTERS TRAINING REGISTRATION
Family Matters (FM)
Program for families with teens to complete on their own time and in the privacy of their own home. Facilitators call participating families periodically to track progress and motivate completion. No meeting space or equipment are necessary to offer this program.
Date *
Required
First Name *
Last Name *
Email *
Phone Number *
If needed, can we reach you by text using the above number? *
Name of your organization, group or school. (Skip if not applicable)
Address of Organization, School, or Group Affiliation
Personal Address (for certification purposes only) *
Continuing Education Hours
Would you like to receive free Continuing Education Hours? *
If yes, please provide license #
The following demographic questions are for reports and funding purposes.
AGE *
Ethnicity: *
Sex *
By checking the boxes below, I agree to the following: *
Required
Thank you for your registration. Our Outreach Coordinator, Chris Serra, will contact you within 5 business days to finalize your registration. If you have any questions of concerns please you may contact Chris by Phone or Email. 916.662.2739 or chris@omniyouth.net
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