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Three Strands Registration
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Is a parenting class voluntary or required for the participant's service plan?
Voluntary
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Participant's First Name
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Participant's Last Name
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Participant Gender
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Female
Male
Other:
Participant's Age
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Participant Phone 1
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Participant Phone 2
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Participant's Email
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Participant's Address
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Participant's Partner Name
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Names / Ages of Kids needing childcare (+ special needs?)
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Name of Referrer
*
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Referrer's Role
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Referrer Phone
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Referrer Email
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