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SMART STEPS CLASSES- SIX RESEARCH-BASED EDUCATION CLASSES FOR RE-PARTNERING COUPLES

Smart Steps Registration Form

Names of Family Members Attending and Ages (Please mark in parentheses after each child's name whether they are biological children of the father (F), mother (M), or both (O):
Who referred you?
Names & Ages of Children:
May we contact them to follow up?
Yes  No 
 

Class Participant Financial Commitment

I agree to pay $20.00 per class.  I understand that I can include additional family members, and agree to pay $20.00 per class for each additional family member who attends.  I understand that in the event family members do not attend one or all of the classes, that I guarantee payment for the missed classes.

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