Growing Great Families - Class Enrollment Form
First Name *
Last Name *
In which class are you enrolling? *
Email Address *
I am a childcare provider and would like STARS credit for attending this class. *
Required
If yes, at which childcare center or for which organization do you work?
Payment Options - please select one from the following choices:
Payment Options - please select one
(if you are enrolling as a couple, please indicate your partner's name, email address & phone number at the bottom of the form)

- $25/person
Payment is expected by the first class in the form of cash, Venmo transfer (@Rachel-Wigglesworth, rachelwigg@gmail.com, or 307-732-0413), or check made out to Rachel Wigglesworth. To secure your spot, please indicate your payment plans below. Checks can be mailed to:
Rachel Wigglesworth
3415 Appaloosa Dr.
Jackson, WY 83001
Payment Options - please select one *
I will pay by: *
Required
If paying by Venmo, you can use this picture to verify you have the correct Rachel Wigglesworth :)
Age(s) of your children
Please enter the age of your child/children below. (Note - there is an option to indicate that you do not have children)
Child 1: *
Child 2:
Child 3:
Child 4:
Child 5:
Parenting Challenges
Optional: Please give Rachel some ideas of the challenges you are working on with your child(ren) at home.
What are your biggest parenting challenges? What are you hoping to get out of this class? Any other comments?
Optional Contact Info:
Mailing address
City
State
Zip Code
Where did you hear about this class? *
Click all that apply. Please add specifics in the "other" category. For example, where you saw the flyer; at which preschool you heard about the class; or if you found out about the class in a different way.
Required
Enrolling as a Couple - Additional Information
Rachel often emails information to parents before or after workshops. Please indicate your partner's name and contact info below:
Partner's First Name
Partner's Last Name
Partner's Email Address
Partner's Phone Number
Thank you!
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy