FLARE Registration

Next Session: March 23rd - May 4th, 2022, 5:30pm - 7:30pm, via Zoom

Name*

First Last

Phone*

Email*

Referring Agency:*

List agency name, contact name and phone number. If self referred, please type self or NA.

Do you have access to reliable internet and a camera enabled tablet or computer?*

If no, please describe need.

In order to participate successfully, would you like to request a reasonable accommodation or interpreter? We will do our best to accommodate.

If yes, please describe need. We will do our best to accommodate.