Connected Conversations - Parent Edition

Your registration information

First Name *

Last Name *

Email Address *

# of Adults Participating *

Is your child a client of Johnson County Mental Health Center?

Yes

No

Dietary Restrictions

Gluten Free

Vegetarian/Vegan

No dietary restrictions

In the space that follows, please describe any additional accommodations you need in order to participate in this event.

Additional Accommodations

If you need an interpreter please tell which language you need in the field provided.

Do you need interpreter services?

How did you hear about this event? *

Other: