Daylight Awareness & Prevention Agency, Inc.
Shining the light on dating violence and domestic abuse.
Programs & Workshops
Shining The Light
Empowerment Shower Registration
Please complete the registration form. All questions must be answered in order to be accepted.
When is your due date?
Age of 1st pregnancy?
Children names and ages
Is the father(s) still involved?
Is there any history of abuse?
Yes, in my current relationship
Yes, In my family
No, not in my current relationship
No, not in my family
Type of abuse if any?
Parents education Level
High School graduate
None of the above
Cell phone number
Thank you for registering for the Empowerment Shower.
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