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Parenting Wisely Registration Info
Please complete this Pre-Survey to be enrolled in an online, self-paced interactive parenting course through The Wenatchee Alliance for Youth and TOGETHER! for Youth.
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* Indicates required question
Email
*
Your email
First & Last Name
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Address
*
Your answer
City
Zip
*
Your answer
Phone
*
Your answer
Gender
*
Male
Female
Prefer not to say
Race
*
American Indian/Alaskan Native
Asian Indian
Asian - Other
Black
Chinese
Filipino
Japanese
Korean
Native Hawaiian/Other Pacific Islander - Guamanian or Chamorro
Native Hawaiian/Other Pacific Islander - Samoan
Native Hawaiian/Other Pacific Islander - Other
Vietnamese
White
Two or more races
Required
Hispanic Origin
*
Cuban
Mexican, Mexican American, Chicano
Puerto Rican
Not Hispanic, Latino(a) or Spanish
Other Hispanic, Latino(a) or Spanish Origin
Required
Primary Language Spoken at Home
*
English
Spanish
Other:
Military Service
*
Currently serve in the Armed Forces
Currently serve in the Reserves
Currently serve in the National Guard
Served in the past, but do not currently serve in the Armed Forces, Reserves or National Guard
Never served
Age(s) of children in the home
*
3-11
11-18
Required
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