CLIENT PROFILE and REGISTRATION FORM

To register, fill out the form below

FULL NAME (required):

ADDRESS:

TELEPHONE (H) (required): TELEPHONE (C):

EMAIL (required):

SIGN UP FOR MONTHLY PARENTING INFORMATION AND TIPS? YESNO

MARITAL STATUS: MARRIEDDIVORCEDSINGLE

HOW MANY CHILDREN DO YOU HAVE?

1. NAME AGE

2. NAME AGE

3. NAME AGE

4. NAME AGE

HAVE YOU ATTENDED PARENTING SESSIONS IN THE PAST, if so, please list?

WHAT ARE YOUR REASONS FOR SEEKING PARENTING ADVICE / JOINING A GROUP CLASS?

WHO MAY WE THANK FOR REFERRING YOU?

WHICH COURSE DO YOU WANT TO REGISTER FOR?

Course Title:

Day of the Week (Please choose) :

Time of course:DaytimeEvening

Date of first session (Day / Month / Year) :


CANCELLATION POLICY:

Private sessions require a 24 hour notice period to avoid cancellation charges.

Private package sessions require that you take all these in the specified time period. No refunds will be given for sessions not used within that time period or cancelled within the 24 hour required notice period.


*By clicking on submit, you confirm that you have read and understand the cancellation policy.

If you would rather fill this out later, download the following form which you can email back to us at info@yourparentingpartner.com