Few Registration Form
Please fill out completely so that your registration may be processed promptly
Name *
Your answer
Gender *
Required
Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Email Address *
Your answer
Social Security # *
Your answer
Home Phone *
Your answer
Work Phone
Your answer
Birth Date *
Your answer
Martial Status *
Have you ever taken a course or workshop from Foundation House Ministries *
If yes, when?
Your answer
If yes, did you complete the program?
Your answer
Are you under court order to attend this workshop or to complete some type of parenting course *
What is your docket number?
Your answer
When is your next court date?
Your answer
Do you have any current pending charges? If yes please explain
Your answer
Are you represented by an attorney? If yes name and Phone #
Your answer
Are you currently participating in any other Foundation House Ministries Program or Classes? If yes please list:
Your answer
Register me for: *
Please register me for the following month: *
TOTAL AMOUNT ENCLOSED OR CHARGED TO CREDIT CARD *
Work Shop Fees:
$45 per person or $60 per couple
Registration
Registration for a workshop requires a $10 NON-REFUNDABLE deposit per person. The remaining tuition will be collected at the first class period. If a workshop is canceled by FHM, your deposit and any balance paid will be refunded. Tuition must be paid in full on or before the first day of the workshop. ALL CHECKS SHOULD BE MADE PAYABLE TO: FOUNDATION HOUSE MINISTIRES. Credit cards may also be used for payment
Credit Card Information: Type of credit card
Credit Card Number
Your answer
Expiration Date:
Your answer
Security Code
Your answer
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