Few Registration Form
Please fill out completely so that your registration may be processed promptly
Name
Your answer
Gender
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Address
Your answer
City
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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
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Expiration Date:
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Security Code
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