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
PLEASE USE EMAIL BELOW FOR DETAILS
AND ACTUAL START DATE
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.