Tuesdays: March 20, 27 and April 3 from 6:00pm - 8:30pm
RequiredRequired Question(s)
Required 1.
Please tell us the child's name.
 

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Required 2.
Children must be at least 8 years old.  Please tell us the child's age.

 

 

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Required 3.
One adult must accompany each child.  Please tell us the name of the adult who will attend class.
 

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Required 4.
Are you or your child overweight?
Yes
No
  • Comment:

  • 500 characters left.
Required 5.

What is the total annual household income including job, business, pension, etc.?

$0-$15,000
$15,001-$25,000
$25,001-$35,000
$35,001-$45,000
$45,001- $55,000
$55,001-$65,000
$65,001-or more
Required 6.
How did you hear about Cooking with CHOICES? 
Health Fair or Community Event
Friend or Coworker
An Email
Facebook
Twitter
Instagram
Other  
  • Comment:

  • 500 characters left.
7.

What device do you use most often for emails & websites?

Smartphone
Tablet
Laptop or Desktop Computer
Other  
8.
Would you be willing to volunteer for a future Cooking with CHOICES class and help new family students?

 

Yes I'll help.
I would like to help in other ways.
Other  
  • Comment:

  • 500 characters left.
Required 9.
Please enter the information below so that we can reach you!

First Name:
Last Name:
Work Phone:
Home Phone:
Email Address:
emailaddress@xyz.com
Address 1:
Address 2:
City:
State/Province
(US/Canada):
Postal Code: