Family Resources & Community Connections, Inc.

Empowering and Positively Impacting Children, Families and Under-served communities by addressing social needs and issues through education, prevention and awareness.

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FRCC Program Registration

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Thank you for your submission. Our program registrar will be in touch soon. Family Resources and Community Connections, Inc.

Who are you registering? (required)

Programs for which you are registering?(required)

Text

Parent/Guardian First Name(required)

Parent/Guardian Last Name(required)

Primary Address (required)

Primary City/State (required)

Zip Code(required)

Email(required)

Phone Number(required)

Preferred Contact Method(required)

Child’s Name (Write n/a if you are registering for an adult or organization focused program.)(required)

Child’s Age (Write n/a if you are registering for an adult or organization focused program.)(required)

Child’s Date of Birth (MM/DD/YY) (Write n/a if you are registering for an adult or organization focused program.)(required)

Child’s Ethnicity/Race(required)

American Indian or Alaskan Native Asian/Pacific Islander Black or African American Hispanic or Latino White/Caucasian American Indian or Alaska Native Asian/Asian American Middle Eastern or North African Native Hawaiian or other Pacific Island Bi-Racial/Multi-Racial Multiple ethnicity/Other Registration for Adult or Organization

Gender(required)

Women/girls Men/boys Non-binary I prefer not to say Registration for Adult or Organization

How did you hear about us?(required)

Do you grant permission for yourself, organization or your child participating in FRCC Programs to appear in any photos from our sessions or on social media or other marketing materials?(required)

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