Thank you for telling us about yourself. This information is used to help the Dempsey Center develop and schedule services for you. Please note, you must complete registration paperwork (including an Acknowledgment of Privacy Policy) before you can access Dempsey Center services. All responses are strictly confidential.

I am registering with Dempsey Center because:(Required)

INFORMATION

Name(Required)
Address(Required)
Select date MM slash DD slash YYYY
Are you under the age of 18?
Email(Required)
You will also be added to our email list, you can unsubscribe at any time
Is this your cell?(Required)
OK to leave a voice or text message?(Required)
Preferred method of messaging:(Required)
Emergency Contact:(Required)
Information regarding Employment and Health Insurance is gathered solely for Dempsey Center grant application and funding purposes. Employment status and/or insurance coverage have no impact on one’s ability to be a client at the Dempsey Center. We will never contact your employer or insurer on your behalf, nor will we submit insurance claims for clients. All personal information provided will be kept confidential.
Employment Status:
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One on One Consultations
Types of Classes + Workshops

Please review our Privacy Policy by clicking the link below. It will open in a new window. You will need to return back to this window to check the box that you have read and understand it and then click Submit.

Dempsey Center Code of Conduct

Please review our Code of Conduct here… Dempsey Center Client Code of Conduct
I have reviewed the Dempsey Center Client Code of Conduct(Required)

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