Parent Education and Family Stabilization Program Registration Form

First name

Last name

Phone

Address

I understand that in accordance with Florida (FAR) Administrative Rule 65C-32.002 my course provider requires verification of identification and that the course provider will maintain identification for the sole purpose of compliance with FAR-65C-32.002

Please Upload Picture Identification (Driver's License, ID, or Military ID)

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Disclaimer: The components of the parenting course are intended for educational purposes only. The presentation of this material is not intended to constitute mental health therapy, give information on specific mental health disorders nor medications to treat mental health disorders. Participants are encouraged to discuss specific mental health questions with a licensed mental health therapist of their choice.