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Healthy You, Healthy Relationships Event Registration
Event Timing: Tuesdays, June 7-28, 6:00-7:30
Event Address: 304 E. Third Street, Alton, IL 62002
Contact us at
programs@ywcaswil.org
or 618 465 7774 ext 206
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Email
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Phone Number
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Your Date of Birth
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Emergency Contact Information: Name
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Emergency Contact Information: Telephone Number
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Please mark which days you will attend. To receive the full benefits of the workshop, we recommend attending every class.
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Tuesday June 7, 2022 6:00-7:30 pm
Tuesday June 14, 2022 6:00-7:30 pm
Tuesday June 21, 2022 6:00-7:30 pm
Tuesday June 28, 2022 6:00-7:30 pm
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Will you require child care?
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If you require child care, please list the number of children and their ages.
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For sliding scale fees, demographic purposes, and grant reporting, please enter your annual household income from all household members.
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Household size
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For demographic purposes and grant reporting, please identify your race/ethnicity.
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White/European descent
Black/African American
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Middle Eastern/North African
Asian/Pacific Islander
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Other:
For demographic purposes and grant reporting, please check any forms of Public Assistance that your household receives.
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TANF (Temporary Assistance to Needy Families)
WIC (Supplemental Nutrition for Women Infants & Children)
SSI (Supplemental Security Income)
Section 8/Public Housing
none of the above
Classes are $15 each, $40 for all four, and sliding scale rates are available. We will notify you if you qualify for a sliding scale fee. I understand that I will have to pay upon arrival.
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