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Family Art Registration Form
Parent and Household Information
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* Indicates required question
Which class are you taking?
Your answer
First Name of Parent
*
Your answer
Last Name of Parent
*
Your answer
Date of Birth of Parent
*
MM
/
DD
/
YYYY
Are you a People's Resource Center (PRC) client?
*
Yes
No
Unsure
If yes, what is your PRC client ID number?
Your answer
Gender of Parent
*
Choose
Male
Female
Address
*
Your answer
Apartment
Your answer
City
*
Your answer
Zipcode
*
Your answer
Phone Number
*
Your answer
Alternate Phone Number (if applicable)
Your answer
Email address
*
Your answer
Country Born In
Your answer
Highest Level of Education
Choose
0-8 years
9-12 years
High School Graduation
Some College
College Graduate
First Language
*
Your answer
Race
Choose
American Indian/Alaskan Native
Asian
Black
Pacific Islander/Native Hawaiian
White
Multi-Racial
Ethnicity
Choose
Hispanic
Non-Hispanic
Income Sources
Employment
Social Security-Disability
Social Security-Retirement
TANF
Child Support
Other:
If you are employed, are you currently working?
Full-Time
Part-Time
Not-Applicable
Clear selection
Approximate Total Monthly Household Income
Your answer
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