NorthStar Church

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Friday April 22th, Saturday April 23rd , Friday May 20th ,Saturday May 21st
April 22nd 6:00 - 9:00 pm Saturday April 23rd 9:00 am-12:00 pm Friday May 20th 6:00 - 9:00 pm Saturday May 21st 9:00 am-12:00 pm (4 sessions)

NorthStar Church
Address is 162 N Tyndall Pkwy, Panama City, FL 32404

English Childcare: Free of Charge * 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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