For Office Use Only Registration form … Please print Check box if you are a Tuality Name _________________________________________________________________________________________ ❏ Healthcare employee or volunteer. Child’s name (if applicable) _____________________________________________________________________________ Child’s age ____________ Address ________________________________________________________________________________________________________________________ City _______________________________________________________________________________ Phone (home) ___________________________ (cell) ______________________________ E-mail State ______________ ZIP ___________________ ___________________________________________ Classes I’d like to take … Class name Start date Time Fee $ TOTAL $ If you’re taking a class from the “Childbirth & Parenting” category, please provide the following information (if applicable): Your physician’s name __________________________________________________________________________________________________________ Expected birth date ____________________________________________________________________________________________________________ Your class partner’s name ______________________________________________________________________________________________________ Payment If paying by mail, please allow at least a week for your payment to be received and processed. ❏ Check enclosed (payable to Tuality Healthcare) Card number Expires Check No: __________ ❏ American Express® ❏ Discover® ❏ MasterCard® ❏ VISA® Name on Card Verification Code Signature Frequently asked questions… “How do I register for a class or classes?” Phone: Call 503-681-1700. Mail: Complete the accompanying form and mail it, with your payment, to: Tuality Health Education Center 334 SE 8th Ave., Hillsboro, OR 97123. Fax: You may fax your registration with credit-card payment to 503-681-1932. Walk-in: Registrations are accepted with payment at the Tuality Health Education Center. “How do I know whether I’m registered for my class?” With sufficient advanced registration notice, we will send you a confirmation letter. Please feel free to call 503-681-1700 at any time for a verbal confirmation. “What happens if the class is already full, or if the class gets canceled?” We will refund your payment. “Why would a class get canceled?” If there are not enough reservations to meet our enrollment requirements, the class will be canceled and you will be notified. “Do you issue refunds?” Yes, with the following requirements. You must request a refund or transfer at least three weekdays before the class begins. You may transfer to another class only once. After you transfer to another class, refunds are not available. For each refund request, we will deduct a $15 processing fee or the total class fee, whichever is less. To register by phone call: 503-681-1700 Or mail registration and payment to: Tuality Health Education Center 334 SE 8th Ave. Hillsboro, Oregon 97123 Or fax registration and payment to: 503-681-1932 (Credit-card payment only.) “What about inclement weather?” If the Hillsboro School District closes due to bad weather, we cancel Tuality’s daytime classes. If Portland Community College cancels evening classes, we cancel Tuality’s evening classes. Watch local media reports for these local cancellations. You may confirm Tuality’s weather-related class cancellations by calling 503-681-1700, option 6. Tuality Healthcare Building a healthier community. Community Education For more information, call 503-681-1700. ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Don’t forget signature for credit card. 09/08