FOR LIFE SERVICES-Community Care, LLC
P.O. Box 8222, Surprise, AZ 85374      602-405-4962 

FLS-CC Registration Forms

Contact Information

Use this form to register for any of our programs, Next Step GED Preparation, Tutoring, Workshops, Camps, Family, Individual or Marital counsulting. You will be contacted within 48 hours from date of submission.  Fees can be paid using PayPal. Feel free to e-mail us at fls_cc@yahoo.com. or call us at 602-405-4962. You deserve to live better....FOR LIFE.

First Name:
Last Name:
Address Street 1:
Address Street 2:
City:
Zip Code: (5 digits)
State:
Telephone:
Date of Birth:
Email:
Comments:

 
All registration fees must be paid prior to being scheduled for service. 
You may pay for all or partial services by using PayPal.com
When using PayPal go to the Send Money page and send to fls_cc@yahoo.com.
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