Parent Child Journey, Winter 2018: Maddux School at Ivymount in Rockville
Thanks for your interest in Dr. Dan Shapiro's ten session parent group located at Ivymount School in Rockville, Maryland. Go to www.parentchildjourney.com for complete information. If you have any questions, contact Dr. Shapiro at drdan@parentchildjourney.com. To register, please provide the following information.
Email address *
PARENT/ GUARDIAN 1 CONTACT *
parent/ guardian 1 full name
Your answer
cell phone *
Your answer
work phone
Your answer
home address *
street address, city, state, zip
Your answer
home phone
Your answer
PARENT/ GUARDIAN 2 CONTACT (if applicable)
parent/ guardian 2 full name
Your answer
home address (if different from above)
Your answer
work phone
Your answer
cell phone
Your answer
email address
Your answer
Information about your child (children)
name(s), age(s), issues/ challenges (in brief)
Your answer
Payment information
To make this class accessible to all, it will run on a pay-what-you-can basis. The registration fee includes all 10-sessions of the parent group with Dr. Shapiro.

To reserve your spot, please make your check payable to Dr. Dan Shapiro and mail to 11705 Magruder Lane, Rockville, MD 20852.

registration *
Thanks for paying what you can.
How did you find out about this program?
For more information, go to: www.parentchildjourney.com
A copy of your responses will be emailed to the address you provided.
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