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Family to Family
Class Registration 2023

Name(Required)

First

Address

Street Address City ZIP / Postal Code

Phone(Required)

Email(Required)

Emergency Contact Name

Phone

Who is the person with the mental health condition (your parent, spouse, sibling, in-law, son, daughter, etc.)?

First

What is your relationship to this person?

First

How old is the person with the mental health condition?

First

What is the diagnosis?

First

How long has he or she had symptoms?

First

Are you involved with their care and/or do you interact with them regularly?

Yes

For in-person classes only: Do you have a handicap that requires accommodation in the classroom?

Yes

How did you hear about the class?

First

Can you attend all classes?

Yes

Maybe

Please do not rotate other family members or send a representative to class

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