ACTIVELYENGAGING CHILDREN AND ADOLESCENTS IN THE COUNSELING AND TREATMENT PROCESS THROUGH THE USE OF CREATIVE CRAFT MAKING 2.5 CEUs for LCSW's, LMHC's & LMFT's

Positive Development, LLC

9521 Shellie Road, Suite 13

Jacksonville, Florida 32257

Phone: 904-516-0913

Email: erica@positive-development.org

Website: www.positivedevelopmentllc.com

Our next middle school cohort of students begins virtually on Thursday, August 22, 2024 from 6:00-7:15 pm online.

Registration is required.

Name of Parent*

First NameLast Name

Parent Email*

example@example.com

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Parent Phone Number*

Area CodePhone Number

Name of Teen*

First NameLast Name

Teen's Phone Number*

Area CodePhone Number

Teen's Age*

Teen's Estimated Emotional Age

Teen's Current Grade *

Teen's Top 3 Primary Interests*

What would you like your child to get out of participating in our program?*

I give permission for my teen to participate in this group*

yes

I give permission for Positive Development to send email reminders and meeting invitations to join the groups to my email address and phone number and to my teen's email address and phone number*

yes

I understand that refunds for the registration of this program or for any program sessions missed by my child are not permitted.*

Yes

I give permission to Positive Development to add me to their newsletter (you may unsubscribe at any time)*

Yes

I understand that individual results may differ for each program participant and that the amount of progress my child makes depends on the effort my child places on using and applying the skills that will be learned in this program. I understand that parent reinforcement of program skills significantly enhances the progress that my child can make.*

Yes

TERMS & CONFIDENTIALITY We respect each and everyone's right to privacy and confidentiality and we shall make sure to maintain it that way. However, please understand that this is not absolute and is limited to provide for by law. Certain limitations are as follows: Threatening one's self or another that may result in physical harm; An act of physical, sexual or emotional abuse against a child. Whenever we are summoned by court order to disclose information against a participant. CONDUCT AND RELATIONSHIP: it is necessary that the following is required to be complied with by members: Discussions made within the group session are not allowed to be discussed outside with anyone and should maintain the practice of confidentiality in order to build trust with fellow members; Members should maintain positivity and not induce disrespect among others; Maintain conduct that brings respect to fellow members' thoughts, emotions, or behavior. Participants realize that group facilitators will set standards for confidentiality but cannot guarantee that other group members will not share information about others*

I understand and agree. I understand that I am responsible for reviewing these terms with my child.

My Products

Balanced Intensity Regular Registration$525.00

Total $0.00

Pay Later Disclosure:*

I understand that I must select the "Paypal" icon below to utilize the pay later option. I understand that I will be charged in full if I select the "debit or credit" card option below.

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

Use the Pay Pal option below to pay in 4 equal payments or to select a 12 month payment plan