100 Old Hampton Lane, Hampton, VA 23669    (757) 727-1300

CLASS REGISTRATION INFORMATION

The following form may be used to submit registration information to Healthy Families. Healthy Families Staff will send a confirmation letter in the mail to confirm your registration to the class. Healthy Families Staff will call only if the class is full or otherwise unavailable. However, submitting the information does not ensure automatic entry to the class of your choice.

Please note that registrations submitted on Fridays and the weekend will not be registered until Monday afternoon. Any registrations that are submitted with less than a week before the start of a class will not receive a confirmation letter in the mail.

Childcare is provided for most parenting classes. There is a fee per class session for Non-Hampton residents.

  

REGISTRATION FORM
 

 

To register for the class, please consult the calendar for classes being offered by clicking here.

Please complete the registration form below:

Name:
Address:
City: State: Zip:
E-mail Address:
Phone Number:
Birth Date:
Employed in Hampton?
Military?
Have you ever taken a parenting course?
Will your children attend with you?
Your children's name(s), age(s), Date of birth
Child's Name Age: DOB:
Child's Name Age: DOB:
Child's Name Age: DOB:
Child's Name Age: DOB:
Your choice for a parenting class?

 
Dates: check class schedule
How did you hear about our program?
(Continue for prenatal registration only, all others please submit your registration information)
Delivering Hospital:
Doctor's Name:
Due Date:

Comments:

 

 

 

 


 
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