Crosspoint Church

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Wednesdays, Sept. 4-Oct. 23 (6-7:30pm)
8 sessions

Crosspoint Church
214 Partin Dr S, Niceville, FL 32578

English Childcare: FREE 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 you need childcare for

PREVIOUS MARRIAGE ENRICHMENT EXPERIENCES Select any programs that you and your spouse have participated in within the last 12 months:

Art of Marriage Laugh Your Way to a Better Marriage Adventures in Marriage None of the Above

Participating Programs Select Programs You Participate in:

None WIC TANF Unemployment "Step Up" School Lunches

Who is filling out this form ?

Husband

Wife

I have read and agree with the terms described in the document.

Best Marriage Ever is a listing of 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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