REGISTRATION FORM – SIX-WEEK PARENTING COURSE

HOW TO TALK SO KIDS WILL LISTEN…

NAME/S:     __________________________________________________________

ADDRESS:   __________________________________________________________

EMAIL/S:    __________________________________________________________

PHONE/S:   ____________________________    ____________________________

CHILD/REN & YEAR OF BIRTH: 

_________________________________________________________

_________________________________________________________

_________________________________________________________

_________________________________________________________

PARENTING CHALLENGES (in order of importance): 1. ___________________________________________________________ 2. ___________________________________________________________ 3. ___________________________________________________________

CLASSES:

Start date:     September 2017

Location:          58 New Dorp Plaza; SI, NY 10306

Tuition:            $398 for first parent; $298 for second parent of same child 

                   Half due with registration  Balance due at the first class 

All information will be kept in confidence and used solely for the purpose of

making the classes more targeted and meaningful to participants and their children.

Who Should Attend:  All Parents with Children from Toddlers to Teens

Text Book, Work Book, Completion Certificate,
light refreshments during class are all included with tuition.