Child Impact Program Registration

Child Impact Program Registration Form

  • If you do not know the Docket# when registering,enter Unknown. Please note, you will need to have the Docket# in order to receive certification that you completed the program.
  • Mailing Address

  • Seminar Sessions

    The seminar consists of two 2-hour sessions. You must attend both sessions Please indicate several choices numbered by preference.

    If the seminars you have selected are unavailable, you will be placed in the next open class

    *Please note that your placement in a particular seminar is not guaranteed until it is confirmed by this office
  • A $25.00 rescheduling fee will be charged for missed classes. Failure to complete the seminar within six months of your initial registration will require payment in full. Cost per person: $85.00 payment accepted by check, money order, Visa, Mastercard or Discover credit card. Registration in seminar will not be confirmed until payment is received.

    Please make checks and money orders payable to Riverbend CMHC.

    If you are on State and/or Federal assistance, or cannot pay the full fee, please contact us at 226-7505 x4039.
  • Price: $85.00 Quantity:
    For "Quantity', please enter the number of people you are paying for. If you are paying for your co-parent, please have them submit their own registration form.
  • American Express