Participant Information

Group Registration
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Building Up Kids: Battling Big Emotions-Beginning February 1st, 2024
GROUP PARTICIPANT'S INFORMATION:
Name of Group Participant*

First NameLast Name
Name of Parent/Guardian of Group Participant (if applicable)

First NameLast Name
Age:*
Sex:*
Address:*
City:*
State:*
Zip Code:*
Participant/Parent/Guardian Phone Number*
Participant/Parent/Guardian E-mail:*
Additional Information/Notes:
Please briefly explain why you are interested in attending this group:
Payment Informaiton
A one-time payment is required prior to beginning the group and no other payment is required. If for any reason you will not be partaking in the group, you will be refunded the full amount. You will be directed to a PayPal Payment system. You do not need to have PayPal. Simply enter in your chosen credit card.
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Building Up Kids: Battling Big Emotions $120.00
6 Week Kids Group

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Payment Informaiton