Family-Child Resources, Inc. York, PA - Recognized Nationally, Statewide, and Locally for our client-focused services

Please use the form below to register for Kids' Groups.

Parent's Name:

Child's Name:

Child's Date of Birth:

Address:

(line 2 of address):

City, State, Zip:

E-mail Address:

Daytime Phone:

Evening Phone:

My child is experiencing/dealing with: (check all that apply)

divorce/separation	substance abuse
death	sexual or physical abuse
low self-esteem	getting along with others
Other: (please explain)

Thank you for your interest in Kids' Groups. The Kids' Group coordinator will contact you soon to set up a screening appointment for you and your child and answer any questions you may have regarding this program.

© Copyright 2008

Family-Child Resources, Inc.
3995 East Market Street · York, PA 17402
Phone: (717) 757-1227 · Fax: (717) 757-1353

Family-Child Resources, Inc.
Square Commercial Center
1 Center Square, Suite 3 · Hanover, PA 17331
Phone: (717) 630-2882· Fax: (717) 630-8161

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