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Mar16-May4 2022-Nurturing Fathers Registration
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* Indicates required question
First and Last Name
*
Your answer
Complete Address (include Street Address, City, State, Zip)
*
Your answer
Email Address
*
Your answer
Cell Number
*
Your answer
Age:
*
Your answer
Parental Status:
*
Not a Parent
Child on the Way
Parent
Grandparent
Foster Parent
Mentor
Required
If you are a Foster Parent, are you a Villages Foster Parent?
Yes
No
Clear selection
How did you hear about this Nurturing Father's Class or Dad's Inc?
*
Your answer
Do you have any history or current Criminal Charges or Child Protective Services cases involving the abuse of children?
*
Yes
No
Do you have consistent access to the Internet for the purpose of a Zoom call?
*
Yes
No
Can you commit to attending and finishing Eight (8) Nurturing Fathers sessions starting on Wednesdays at 6:30 p.m.?
*
Yes
No
Are you able to set aside uninterrupted time for each Wednesday Evening Class from 6:30 pm until 8:00 pm?
*
Yes
No
How do you feel about your fatherhood experience so far?
*
Excellent
Good
Fair
Poor
Are you open to improving your Fatherhood and Relationship skills?
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Yes
No
What obstacles get in the way of you being the best Father you can be?
*
Your answer
How can Dads Inc/Nurturing Fathers help with improving your Fatherhood skills?
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Your answer
How do you best learn? (check all that apply)
*
Books
Audio-Visual
Discussion
Small Groups
Private Study
Assignments
Other:
Required
What will you bring to the Nurturing Fathers Class experience? (check all that apply)
*
Positive Energy
Shared Experience
Listening Ear
Verbal Support to Others
Nothing
Other:
Required
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