Bethesda House Training Registration Form

*If you are filling out this form on behalf of a child, please fill out Name, Email Address, and Cell Phone with the information of the parent/guardian and the rest with the information of the child.  Please share the child's/children's names in the other comments section.

Name *
Date of Birth
Date of Birth
Select the seminar or workshop that you are applying for
Date of Seminar/workshop *
Date of Seminar/workshop
Photo/video release *
Our staff may be discreetly taking photos or video during this seminar to be used for news or promotional purposes, including print and electronic materials, social media, and our website.