The Church at the Beach

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Saturday Feb.12th 10:00am-4:30pm (Lunch included) Saturday Feb. 26th 9am-12:00pm Sunday March 6th 12:30-3:30pm
Feb 12 thru March 6 (3 Sessions)

The Church at the Beach
10620 Hutchison Blvd, Panama City Beach, FL 32407

English Childcare: No fee * 17 Miles Away

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Husband First Name
Last Name

Date of Birth

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

Wife First Name
Last Name

Date of Birth

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

Mailing Address same as Husband

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 ?

Husband

Wife

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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