Parenting While Black Workshop Thursdays, February 9th-March 30th 6:30pm-8pm

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Registration Form

*Please note that there will only be one stipend issued per household. If two parents are attending, please note both names on the form.

Your name: *

Your Race *

Black or African American

White

Hispanic

Other

Your email address: *

Your phone number: *

Do you need childcare during the workshop? *

Yes

If you answered "yes" to needing childcare, please list the names, gender, ages and school(s) of your children. *

Would you like to receive dinner from 6-6:30pm before the workshop? *

Yes

Do you have any dietary restrictions? If yes, please list below.

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