Anger Management Registration Form

Anger Management Registration Form
The anger management program consists of 8 class sessions and will be held on Wednesdays and Thursdays from 4:00 PM - 5:00 PM. This program is for youth ages 12-17. All sessions will be virtual. After you complete the registration form, you will receive a zoom link via email with login instructions.
Participant Information
Name *

First Name Last Name
Age *
Gender *

Male Female
What school do you attend?
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Email *
example@example.com
Parent's signature below gives permission for the youth to participate in the anger management class.
Signature *

Clear
Should be Empty:

Participant Information