Make Parenting a Pleasure

Register

Fill in your details — we'll send codes to confirm your phone and email.

Participant Info

First Name *

Last Name *

Date of Birth *

Address Line 1 *

Address Line 2

City *

State *

Zip *

Email address *

Phone number *

Are you enrolled in the Oregon Health Plan? * -- Select -- Yes No

Are you receiving TANF? * -- Select -- Yes No

Is your participation court mandated? * -- Select -- Yes No

Class participants

First Name

Last Name

Date of Birth

Are they receiving TANF? -- Select -- Yes No

Are they enrolled in OHP? -- Select -- Yes No

Are they court mandated? -- Select -- Yes No

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Child Care

Quality child care available for children ages 18 months to 8 years of age.

Will you be needing childcare during this class? -- Select -- Yes No

Child Care Details: Please specify names and ages of children

If anyone in your party has any special needs or food allergies, please provide details:

Additional Details

How did you hear about this class? -- Select -- Billboard Community Organization Facebook / Social Media Flyer Postcard Shopping Guide Word of Mouth Other

Please explain:

What do you hope to get out of this class?

This class provides food. Please note any dietary restrictions.

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