Registration - March 26, 2020 Adolescent Brain Development Workshop Series with Karen Dudgeon
This workshop series taught by counselor, Karen Dudgeon, LCSW, is for any adult with an adolescent in their lives. Participants will receive a free copy of the book, Brainstorm: The Power and Purpose of the Teenage Brain, by attending any individual session, but we hope you attend all five. Pre-registration strongly encouraged to allow for us to order enough food, but please come regardless! Dinner 5:00-5:30pm. Workshop 5:30-7:30pm.
Download an 8 1/2 x 11 flier here: or an 8 1/2 x 14 flier with a more detailed description here: . PLEASE COMPLETE REGISTRATION FOR EACH WORKSHOP IN THE SERIES YOU PLAN TO ATTEND.
Email address *
Last Name *
Your answer
First Name *
Your answer
Phone Number
Your answer
Do you plan to join us for the free dinner? (Likely pizza, salad and water. We apologize we cannot accommodate food allergies or sensitivities.) *
Will you be bringing any children requiring the free childcare? *
If bringing children please indicate how many and their ages below. Please be aware that a parent or guardian will be required to sign a waiver on site and must remain in the workshop for the child to utilize the childcare. If you leave the building for any reason you must bring your child with you.
Your answer
Please share some basic information with us to help us better serve the community in the future. Check all that apply. Are you a .... *
Please indicate any school district affiliations (where you teach, reside or child attends school). Please check all that apply.
We cannot offer CEU's but we can provide a completion certificate for personal or employer use. If you would like to be provided with a completion certificate please ensure your full name on this registration is accurate, and below, please state your profession/title (eg. school nurse, school social worker, 7th grade social studies teacher, DSS caseworker, etc.), and your employer if this will be used for your work. Completion certificates will be distributed at the end of each session for anyone who completes this section of the registration.
Your answer
If you are a Medicaid recipient, do you need assistance with transportation to this workshop series? If YES, please provide your phone number or email - whatever is the best method to contact you.
Your answer
A copy of your responses will be emailed to the address you provided.
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy