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Post Deployment Spouse Academy Registration Form : Spouse October 4-6, 2011 *PLEASE PRINT CLEARLY* Last Name: _______________________ First Name: ____________________ Unit (please list Company & Battalion) : ______________________________ Sponsors Rank: ______ Sponsor’s Name: _____________________________ Home Phone: ______________________ Cell: ________________________ E-mail Address: __________________________________________________ Number of duty assignments: _________ How many years have you been married? ____________________________ Do you have children? q Yes q No If yes, please list their ages: __________ How many deployments have you been through? ______________________ This course is for married couples who have been through one or more deployments. By attending the PDSA you agree to active participation in individual and group activities as conducted by the facilitators of the course. Children are not permitted at the course; please contact Child, Youth, & School Services or your local provider to make child care arrangements. Registration Deadline is Friday, September 23, 2011. Once registration has been completed, you will receive a welcome packet via e-mail with the course description and helpful notes. Space in the course is limited; if for any reason you must cancel your registration you must notify ACS prior to the course dates in order to allow us to fill your slot with a waiting couple.

q I have read and understand and agree to the terms of enrollment into the Post Deployment Spouse Academy (PDSA). _________________________________________ Printed Name _________________________________________ Signature _________________________________________ Date

____________ ACS Staff ____________ Date


Post Deployment Spouse Academy Registration Form : Soldier October 5, 2011 *PLEASE PRINT CLEARLY*

Last Name: ________________________ First Name: __________________ Unit (please list Company & Battalion) : ______________________________ Rank: ______ Spouse’s Name: ______________________________________ Home Phone: ______________________ Cell: ________________________ E-mail Address: __________________________________________________ Number of years of service: ______Number of duty assignments: _________ How many years have you been married? ____________________________ Do you have children? q Yes q No If yes, please list their ages: __________ How many deployments have you been through? ______________________ This course is for married couples who have been through one or more deployments. By attending the PDSA you agree to active participation in individual and group activities as conducted by the facilitators of the course. Children are not permitted at the course; please contact Child, Youth, & School Services or your local provider to make child care arrangements.

Registration Deadline is Friday, September 23, 2011. Once registration has been completed, you will receive a welcome packet via e-mail with the course description and helpful notes. * Soldiers attending the PDSA will only attend on Day 2 of the course for joint activities. Signature is required from the Soldiers Commander/1SG/CSM in acknowledgement that Soldier will be in attendance. Space in the course is limited; if for any reason you must cancel your registration you must notify ACS prior to the course dates in order to allow us to fill your slot with a waiting couple.

q I have read and understand and agree to the terms of enrollment into the Post Deployment Spouse Academy (PDSA). _________________________________ Printed Name _________________________________ Signature _________________________________ Date

______________________________________ Commander’s Signature ______________________________________ Printed Name

____________ ACS Staff ____________ Date

__________________ Date

________________ DSN Number


Post Deployment Spouse Academy Confidentiality Form October 4-6, 2011

The Post Deployment Spouse Academy requires active participation in both group and individual activities. The content of the discussions, the sharing of personal information or personal experiences will remain confidential. By signing this agreement, I agree not to disclose anything shared by others during the PDSA outside of the seminar. Furthermore, I also agree not to reproduce any of the content or materials provided to me during the PDSA for copyright purposes.

_________________________________________ Spouse Printed Name _________________________________________ Signature _________________________________________ Date

_________________________________________ Soldier Printed Name _________________________________________ Signature _________________________________________ Date

____________ ACS Staff ____________ Date


Spouse Academy Registration form