Vive City Chapel

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Sat 9/18 9am-3:30pm; Sun 9/19 2pm-5pm; Sun 10/17 2pm-5pm
Sep 18, Sep 19, Oct 17 (3 sessions)

Vive City Chapel
15651 NW 6th Avenue, Miami

English Childcare: No charge* 17 Miles Away

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SPOUSE 1 First Name
Last Name

Date of Birth

Cell Phone #Format: 555-456-7890
Email Address
Street Address
City
State
Zip
Gender

SPOUSE 2 First Name
Last Name

Date of Birth

Cell Phone #Format: 555-456-7890
Email Address

Mailing Address same as SPOUSE 1

Street Address
City
State
Zip

Gender

Childcare Do you need childcare?

Yes No

# of Children?

Participating Programs Select Programs You Participate in:

None WIC TANF Unemployment "Step Up" School Lunches

Who is filling out this form ?

SPOUSE 1

SPOUSE 2

Bring proof of participation in at least one of those programs and payment for the child care with them to the first class session.

AIM Classes is a full listing of Adventures In Marriage classes available in the state of Florida - brought to you by Live the Life.

Funding for this project was provided by the United States Department of Health and Human Services, Administration for Children and Families, Grant: #90ZB0021. These services are available to all eligible persons, regardless of race, gender, age, disability, or religion.

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