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Understanding Separation Anxiety & School Refusal: A Workshop for Parents
September 26 & 27    10:30am - 12:00pm 
Location: Encino, CA 

Pricing: 
After September 1st- $150
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What Date are You Registering For?  *

First and Last name  *
Date of Birth *
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Address  *

Phone Number 

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Marital Status *
Occupation *
Employment Status *
What are the age(s) of your kid(s)? *
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Please type your full name below as your digital signature for this form. *

Thank you for registering for our workshop! We’re excited to have you join us. Please note that registration fees are non-refundable. However, if you need to switch your attendance between September 26th and September 27th, we may be able to accommodate you, depending on space and availability.

Below, you’ll find the payment details to complete your registration:

September 26th Registration Payment 

September 27th Registration Payment

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