Parenting Wisely Registration

Private, non-profit organization offering professional counseling and prevention services.

Thank you for your interest in the Parenting Wisely Online Program!

Please complete the following form so our staff can contact you for the next steps in the registration process. This program is designed to offer support to families in Broome and Cortland Counties. This program is not intended as professional development for service providers. If you are a service provider looking for further details:

Service providers can contact Melissa Simmons for more information:

Phone: (607) 756-8970
E-mail: msimmons@familycs.org

There is no fee to participate in this program!

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Comments

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Parent Information

First name*

Last name*

Email*

(Most materials will be sent to you through this email address)

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

How did you hear about our program?

Children Information

Children Details*

In this section please provide information about each of your children including their first and last name as well as their age. To add more children click on the + sign

Child's First and Last Name

Child's Age

Comments

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If you or someone you are with is experiencing an overdose, please dial 911 for immediate assistance.

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