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2. *ALL FIELDS MUST BE COMPLETED IN ORDER FOR US TO ACCEPT AND PROCESS YOUR REGISTRATION.

   (Note: At present no fee is required for "Why Try" Classes.  Registration must be submitted one (1) week prior to start date of class.)

   “WHY TRY” are exciting classes that are changing students from being unmotivated to engaged, from failing to graduating, from feeling hopeless to becoming resilient.  These 10-session classes for youth of all ages offers ten visual metaphors covering important life skills that are reinforced through relevant music, videos, learning activities, and journals.

4. Date: *
   Date:
6. 1) PARENT/GUARDIAN LEGAL NAME*
8. STREET ADDRESS & NUMBER *
10. CITY *
11. STATE *
12. ZIP CODE *
14. PHONE: *
15. SECONDARY PHONE:
17. E-MAIL ADDRESS: *
18. EMPLOYED?*

    1. YES
    2. NO
20. 2) PARENT/GUARDIAN LEGAL NAME*
22. STREET ADDRESS & NUMBER*
24. CITY*
25. STATE*
26. ZIP CODE*
28. PHONE:*
29. SECONDARY PHONE:
31. E-MAIL ADDRESS:*
32. EMPLOYED?*

    1. YES
    2. NO
34. NAME OF YOUTH ATTENDING:*
35. AGE*
37. NAME OF YOUTH ATTENDING*
38. AGE*
40. Contact: Christiana ("Why Try" Instructor)

    Greene County Family and Children First

    158 E. Main Street

     Xenia, Ohio 45385

    Phone: (937) 562-5600

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42. 1. Receive an email copy of this form.
43. Email address

    This field is not part of the form submission.

44. Submit Submit and Print

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