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Parent Education Program Registration
If you need assistance completing the registration form or if you would prefer to complete a printable version of this form, please contact Jessica Zucchino. Email |
jessica.zucchino@ncsu.edu
or Phone | (828) 688-4811
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* Indicates required question
Email
*
Your email
Contact Information
This information will only be used to contact you in case of class cancellations, additional registration information, and to update you on any changes regarding your selected program.
Name
*
First, Last
Your answer
Phone
*
Your answer
Since we aren't able to offer childcare with virtual programming, we have created activity boxes for the children in the home. Would you like to receive the activity kit?
*
Yes
No
If so, how many children are in the home?
1
2
3+
Clear selection
Please list the age/s of your child/ren.
*
Your answer
Do you have concerns about internet connectivity that might prevent you from attending a program?
*
Yes
No
Please provide us with your home address. This will only be used for direct correspondence with you (mailing activity boxes, food certificates, thank you notes, etc.)
*
Your answer
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