Moraga Parenting Seminar Series Registration Form

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Thank you for taking time to complete this registration form. Your answers will help us to learn more about you and better serve you and your family. Your name will be kept confidential and we will not ask about immigration status. Your responses will not affect any services you receive and will be use to remind you of the Seminar and send you the zoom link. Thank you!

Email *

Seminar topic in which you are enrolling? *

The Power of Positive Parenting 8/24/2021

Positive Parenting with Children with a disability 9/28/2021

Friends and Peer Relationships 10/26/2021

Coping with Anxiety 11/11/2021

Building teenager Survival skills 10/7/2021

Raising resilient Children 1/25/2022

Raising confident, competent children 2/22/2022

Helping your child reach their potential 3/22/2022

Changing Problem behavior into positive behavior 4/26/2022

Required

Your Full Legal Name *

Gender *

Female

Male

Prefer not to say

City of Residence *

Best Phone Number to Contact You *

With what race/ethnic group do you most identify? *

African American/Black

American Indian/Alaska Native

Asian

Hispanic/Latino

Middle Eastern/North African

White

More than one

Other:

What are the ages of the children living with you? Please include the child/teen you have selected to focus on for this class and any other children or teens living in your home. *

0-5 years

6-12 years

13-19 years

Other:

Required

Name of the school your children are attending

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