Section 1 of 2
Bal-A-Vis-X Foundational & Intermediate Training July 17 & 18, 2023
Please fill in information where requested or required
Email
This form is collecting emails.Change settings
Section 2 of 2
Training Information
Please fill out appropriate sections below
Bal-A-Vis-X 2 Day Foundational and Intermediate Training ($290.00 Registration Fee)
Please complete the form below to register. Type your answers on the line below the section title. A confirmation email will be sent once we have received your completed form and registration fee.
Times: 8:30-5:30 each day with sign in each day 8:00-8:30. One hour for lunch on your own.
Address: Wethersfield High School Gymnasium, 411 Wolcott Rd., Wethersfield, CT 06109
Please contact Debbie Wilkinson at: debodellwilkinson@gmail.com for any questions or additional information.
Please complete the form below to register. Type your answers on the line below the section title. A confirmation email will be sent once we have received your completed form and registration fee.
Times: 8:30-5:30 each day with sign in each day 8:00-8:30. One hour for lunch on your own.
Address: Wethersfield High School Gymnasium, 411 Wolcott Rd., Wethersfield, CT 06109
Please contact Debbie Wilkinson at: debodellwilkinson@gmail.com for any questions or additional information.
Bal-A-Vis-X 2 Day Foundational and Intermediate Training ($290.00 Registration Fee)
Please complete the form below to register. Type your answers on the line below the section title. A confirmation email will be sent once we have received your completed form and registration fee.
Times: 8:30-5:30 each day with sign in each day 8:00-8:30. One hour for lunch on your own.
Address: Wethersfield High School Gymnasium, 411 Wolcott Rd., Wethersfield, CT 06109
Please contact Debbie Wilkinson at: debodellwilkinson@gmail.com for any questions or additional information.
Please complete the form below to register. Type your answers on the line below the section title. A confirmation email will be sent once we have received your completed form and registration fee.
Times: 8:30-5:30 each day with sign in each day 8:00-8:30. One hour for lunch on your own.
Address: Wethersfield High School Gymnasium, 411 Wolcott Rd., Wethersfield, CT 06109
Please contact Debbie Wilkinson at: debodellwilkinson@gmail.com for any questions or additional information.
Loading...
Please check box below for occupation:
Please check box below for occupation:
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Rating
New
Multiple choice grid
Checkbox grid
Date
Time
Teacher, gen. ed.
Occupational Therapist
Physical Therapist
SLP
Social Worker/LCSW
School Psychologist
Add option
or
add "Other"
…
Answer key
(0 points)
Loading...
Name
Name
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Rating
New
Multiple choice grid
Checkbox grid
Date
Time
Answer key
(0 points)
Loading...
Phone Number
Phone Number
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Rating
New
Multiple choice grid
Checkbox grid
Date
Time
Answer key
(0 points)
Loading...
Address
Address
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Rating
New
Multiple choice grid
Checkbox grid
Date
Time
Answer key
(0 points)
Loading...
Employment
Employment
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Rating
New
Multiple choice grid
Checkbox grid
Date
Time
Answer key
(0 points)
Loading...
Check payment option below:
Check payment option below:
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Rating
New
Multiple choice grid
Checkbox grid
Date
Time
Check: Make checks payable to: BAVXCT, LLC Debbie Wilkinson, Manager/Member and mail to: BAVX CT, LLC, c/o Debbie Wilkinson, 4 Howard Ave., Branford, CT 06405
Venmo: @BAVX_CT
Add option
or
add "Other"
…
Answer key
(0 points)
Loading...
Payment Policy: Full payment of registration fee is due at the time of registration unless prior arrangements have been made.
Cancellation Policy: Participants may transfer their registration fee to another person at any time at no cost. See the information below for cancellation and refund deadlines.
45 days prior to training 100% refund
15 days prior to training 50% refund
14 days prior to training or there after no refund will be provided
Cancellation Policy: Participants may transfer their registration fee to another person at any time at no cost. See the information below for cancellation and refund deadlines.
45 days prior to training 100% refund
15 days prior to training 50% refund
14 days prior to training or there after no refund will be provided
Payment Policy: Full payment of registration fee is due at the time of registration unless prior arrangements have been made.
Cancellation Policy: Participants may transfer their registration fee to another person at any time at no cost. See the information below for cancellation and refund deadlines.
45 days prior to training 100% refund
15 days prior to training 50% refund
14 days prior to training or there after no refund will be provided
Cancellation Policy: Participants may transfer their registration fee to another person at any time at no cost. See the information below for cancellation and refund deadlines.
45 days prior to training 100% refund
15 days prior to training 50% refund
14 days prior to training or there after no refund will be provided
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Rating
New
Multiple choice grid
Checkbox grid
Date
Time
I have read and understand the payment policy and cancellation policy.
Please check if you are an employee of the Wethersfield School district
Add option
or
add "Other"
…
Answer key
(0 points)
Loading...
How did you hear about the training?
How did you hear about the training?
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Rating
New
Multiple choice grid
Checkbox grid
Date
Time
Social Media: Facebook or Instagram
Colleague
School System
Option 4 Joe Brummer Connection
Other:
Add option
…
Answer key
(0 points)
Loading...
Link to Sheets
Message for respondents
This form is no longer accepting responses
Summary
Question
Individual
Insights
Total points distribution
Loading...
Settings
Responses
Manage how responses are collected and protected
Presentation
Manage how the form and responses are presented
Defaults
Form defaults
Settings applied to this form and new forms
Question defaults
Settings applied to all new questions