INDIVIDUAL MENTORING NOW !
CALL BEGINNINGS 278-3355
CLASSES STARTING FALL 2011
Print, fill out, and mail form to:
Beginnings Care For Life Center
c/o Men's FraternityClass
213 Marshall Street
Coldwater, MI 49036
Men's Fraternity
Registration Form
Name(s): ________________________________________________ Phone: ____________________
Address: ____________________________________City: ______________________ Zip: _________
E-Mail: ___________________ How did you find out about this series? _________________________
Have you ever participated in the Earning & Learning program before? _________
If so, with whom? ___________________________________________________
I hereby acknowledge that I am participating in the Men's Fraternity class voluntarily. I understand that it is a Christian-based approach to parenting. Beginnings Care for Life Center(BCFLC) does not necessarily condone or recommend all of the information and practices presented by the materials included in the Fatherhood Involvement Program and will not be held liable for any problems associated with the information or ideas suggested by these materials.
I hereby agree to Waive, Release and Hold Harmless BCFLC, their agents, officers, directors and affiliates for any and all present and future claims that I might have or which may accrue, for harm done as a result of any negligence of any of them.
I give permission for BCFLC to use pictures of me or my family members, taken during the Fatherhood Involvement class, for the purpose of promoting their organizations’ activities and services.
Signature(s) of Participant(s)
____________________________________________ Date ___________________________
Beginnings Earning & Learning Program points will be given for participation in this class. If you are a client of the center and would like to receive points, please check here: _______________
For Office Use Only:
Registration Processed By: _________________ E & L Referral Slip Given by: ___________________________