Parent Class Registration Form Please enable JavaScript in your browser to complete this form.Name *FirstLastAddress *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone *Email *Multiple Items *Emotional Parenting ClassThis is a six-week course. The class will be held once a week starting April 18, 2023. I understand *the class price is $456. If I am unable to attend this amount is non-refundable as it reserves your spot in my class due to limited availability. Child Care *I will need Child Care during the classI will not need Child CareHow many kids will be in Child CareCost: $10 per child per week Child #1 Name, Age and and important info (allergies, toileting needs, behavior concerns etc. )Child #2 Name, Age and and important info (allergies, toileting needs, behavior concerns etc. )Child #3 Name, Age and and important info (allergies, toileting needs, behavior concerns etc. )Child #4 Name, Age and and important info (allergies, toileting needs, behavior concerns etc. ) Child #5 Name, Age and and important info (allergies, toileting needs, behavior concerns etc. ) Additional Charge added for Child CarePlease list the cost for Child(ren) hereSquare *CardName on CardSubmit